Dermatology-Rheumatology Connective Tissue Disease Program

Overview

The Dermatology-Rheumatology Connective Tissue Disease Program is a collaboration between Massachusetts General Hospital Departments of Dermatology and Rheumatology. Autoimmune diseases such as lupus, scleroderma or dermatomyositis significantly impact both the skin and musculoskeletal system. Improved management of these conditions comes from periodic evaluation by both a dermatologist and a rheumatologist.

Conditions We Treat

• Scleroderma (diffuse or CREST)
• Eosinophilic fasciitis
• Calcinosis cutis
• Raynaud’s
• Lupus
• Granulomatous dermatitis with arthritis
• Dermatomyositis or polymyositis
• Sarcoid
• Undifferentiated Connective Tissue Disease
• Mixed Connective Tissue Disease
• Digital ulceration
• Schnitzler’s syndrome
• Subacute cutaneous lupus (SCLE)
• Discoid lupus
• Tumid lupus
• Cutaneous vasculitis
• Livedo reticularis
• Suspicion of a connective tissue rash
• Psoriasis with severe arthritis, failing 3 prior systemic treatments
• Neutrophilic dermatoses (PNGD, EED)
• Panniculitis (erythema nodosum, lupus panniculitis, erythema induratum)

Expert Care

Founded by Dr. Gideon P. Smith, an expert in this field, the Dermatology-Rheumatology Connective Tissue Disease Program provides comprehensive care for patients with skin problems associated with arthritic related diseases such as rheumatoid arthritis, lupus, scleroderma, and connective tissue disease.

Dermatologist Flavia Fedeles, MD, MS joined the Connective Tissue Disease Program in 2018 and currently serves as the Director of the Program. She is double boarded in dermatology and dermatopathology, and is Instructor in Dermatology at Harvard Medical School. She graduated summa cum laude from Connecticut College and completed her medical degree at University of Connecticut. She completed her dermatology residency at Brown University and her fellowship at Tufts University. She has authored journal articles and book chapters in clinical dermatology and has a wide range of clinical experience in the diagnosis and management of skin disorders. She has a special interest in connective tissue diseases and clinical research.

Dermatologist Janice Tiao, MD joined the Connective Tissue Disease  Program in 2020. Dr. Tiao is a dermatologist and Instructor in Dermatology at Harvard Medical School. She graduated with highest honors from Princeton University with an undergraduate degree in history and received her medical degree from the University of Pennsylvania. She completed her dermatology residency at Boston University Medical Center. Her clinical interests include autoimmune connective tissue diseases and skin of color.

Multidisciplinary Care Team – Rheumatology Providers

The Massachusetts General Hospital Rheumatology Unit provides expert care for rheumatic diseases and is ranked highly by U.S. News & World Report. Members of the Rheumatology Unit participating in this clinic are known nationally for their clinical and research leadership, including:

• Sheila Arvikar, MD
• April Jorge, MD
• Mark Matza, MD, MBA

What to Expect

Since this is a specialty clinic, patients are referred by a healthcare professional. During an initial consultation, the patient's skin, hair and nails are examined for disease involvement by the attending dermatologist, including specific skin exam techniques for evaluating disease risk and severity in autoimmune disease. The joints and muscles are also evaluated by the rheumatologist fellow and attending. Prior blood tests, radiologic studies and skin biopsies, if these have been performed, are evaluated and if necessary additional testing discussed with the patient. Based on the patient's history, overall condition, and degree of immune system compromise, a personalized treatment plan is recommended based on:

• Cutaneous manifestations of disease in skin hair or nails
• Joint and muscle manifestations
• Results of skin biopsy, microscopic evaluation and blood analysis
• Both the manifestations of the patient’s autoimmune disease and their overall health and lifestyle

Dr. Fedeles and Dr. Tiao work closely with the Rheumatology Unit to tailor a treatment plan to fit a patient’s unique medical situation. Often patients will have previously received treatments for their underlying disease, but which still leave the patient with significant disease-associated problems such as disabling Raynaud’s, progressive skin scarring or hair loss. The objective is to provide a comprehensive medical approach to all aspects of the patient’s condition.

Current Clinical Trials

If you are 18 years or older and have morphea or discoid lupus erythematosus, you may qualify for research studies. To learn more, please visit our skin studies web page.

To Refer a Patient

For Mass General referring physicians, please refer through the CRMS system.

For referring physicians outside of Mass General, please call 617-726-2914, Press 1 and ask for the Connective Tissue Diseases Coordinator.