Explore This Treatment Program
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
- Granulomatous dermatitis with arthritis
- Dermatomyositis or polymyositis
- Undifferentiated Connective Tissue Disease
- Mixed Connective Tissue Disease
- Digital ulceration
- Schnitzler’s syndrome
- 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)
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. Dr. Smith completed a Sulzberger Fellowship at New York University Langone Medical Center where he specialized in psoriatic arthritis and scleroderma. He received a number of awards for recognition of his work and has expertise in connective tissue disease, dermatology-rheumatology, psoriatic arthritis, and scleroderma. Dr. Smith is fluent in Spanish.
Dermatologist Flavia Fedeles, MD joined the Connective Tissue Disease Program in 2018. Prior to coming to Mass General, Dr. Fedeles was an attending dermatologist at the Lahey Clinic, where she practiced dermatology and was involved with teaching of Harvard Dermatology residents and Nurse Practitioners. She also completed a fellowship in Dermatopathology at Tufts University Medical School. Dr. Fedeles is accepting new patients and she is fluent in French and Romanian.
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 Dr. Fedeles, including specific skin exam techniques for evaluating disease risk and severity in autoimmune disease. The joints and muscles are also evaluated by the rheumatologist 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 works closely with Mass General’s 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. Our objective is to provide a comprehensive medical approach to all aspects of the patient’s condition.
Current Clinical Trials
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.
Multidisciplinary Care Team
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:
- Assistant Professor of Medicine, Harvard Medical School
- Co-Director Vasculitis and Glomerulonephritis Center
- Director, Clinical Rheumatology
- Clinical Director, Rheumatology Unit
- Instructor in Medicine, Harvard Medical School
- Department of Medicine