There is no such thing as a cure for dermatomyositis anti-MDA-5 positivity; anti-MDA-5 antibody is a predictor of the risk of progression of interstitial lung disease in dermatomyositis, and anti-MDA-5 positivity usually means that the condition is critical and requires aggressive treatment. Dermatomyositis is an idiopathic inflammatory myopathy that often presents with symmetrical proximal muscle weakness and purplish papules on the skin. Interstitial lung disease is a common complication in patients with dermatomyositis, and its resulting respiratory failure is the leading cause of death, so early treatment and intervention are important to improve the patient’s prognosis. For anti-MDA-5 positive acute progressive interstitial lung disease, it can cause a rapid decline in lung function in a short period of time, leading to respiratory failure and even death. There are no very mature and effective therapeutic measures. For critically ill patients in a life-threatening state of respiratory failure, ECMO support is recommended while waiting for drugs to take effect or during lung transplantation. Lung transplantation may be attempted in patients in whom medications have failed. Positive anti-MDA-5 in dermatomyositis usually means that the condition is critical, and patients should be seen promptly and treated as prescribed.