Lupus Program

Overview

The Lupus Program, within the Rheumatology Unit at Massachusetts General Hospital, provides comprehensive and individualized care to patients with lupus. April Jorge, MD, is the Director of the Lupus Program at Mass General. All physicians in the Rheumatology Unit are highly experienced in caring for lupus patients. Our rheumatology experts work as a team with other world-class specialists throughout the hospital to manage care for lupus patients. We are dedicated to advancing lupus care, and we also lead innovative research to improve outcomes for people with lupus.

Our Doctors

• April Jorge, MD (Director)
• Marcy Bolster, MD
• Flavia Castelino, MD
• Jacquelyn Nestor, MD, PhD
• Sara Schoenfeld, MD
• Sebastian Unizony, MD

Treating the Multi-organ Nature of Lupus: A Team Approach

Lupus is an autoimmune disease in which the patient's immune system attacks the skin, joints, kidneys, blood cells, brain and other healthy tissues and organs. Characterized by periodic episodes of inflammation, the condition impacts each individual differently and causes symptoms ranging from mild to severe.

At the Mass General Lupus Program, we take a multidisciplinary approach to treating lupus. Our rheumatologists work as a team with other world-class specialists throughout the hospital to manage care for lupus patients. These specialists include:

• Dermatologists
• Nephrologists
• Pathologists
• Neurologists
• Hematologists
• Cardiologists
• Pulmonologists
• Ophthalmologists
• Maternal Fetal Medicine

In our innovative combined Dermatology-Rheumatology clinic, our rheumatologists see patients with lupus and other connective tissue diseases alongside expert dermatologists.

Our rheumatologists also work side-by-side with scientists in the Center for Immunology and Inflammatory Diseases to improve our understanding of lupus and develop better, more effective treatments. This close "bench-to-bedside" collaboration between clinicians and scientists has been instrumental in enhancing the quality of care for our lupus patients.

What to Expect

All physicians in the Rheumatology Unit are highly experienced in caring for lupus patients. Because a single test cannot confirm whether a patient has lupus, our rheumatologists perform evaluations to make this diagnosis based on medical history, symptoms, physical examination, and blood tests. Our Clinical Immunology Laboratory is particularly skilled in analyzing blood samples for certain antibodies that are present in most people with lupus.

We strive for prompt diagnosis and treatment of lupus. Your individualized treatment plan will depend on several factors, including extent and severity of organ damage. We also consider the nature of your lupus, as the process may be caused by inflammation or by a hypercoagulable state (a condition in which blood clots tend to form).

Access to Both Traditional & Emerging Therapies

Although there is no cure for lupus, we offer therapies that help patients lead active lives by managing disease symptoms. Common treatment approaches include:

Conventional immunosuppressive medications, which are designed to dampen the inflammatory responses associated with lupus

Anti-malarial medications (including hydroxychloroquine), which were first developed to treat malaria but are also effective in helping control lupus

In addition, our patients can take part in clinical trials that provide access to new and promising therapies. Our patients have access to cutting-edge clinical trials through the Lupus Clinical Investigators Network (LuCIN) and the NIH Autoimmune Center of Excellence.

Browse open clinical trials

Because of the intermittent and relapsing nature of lupus symptoms, most of our patients receive lifelong care at Mass General. However, if you do not live in the area, we can co-manage care with your local physician and see you once a year to monitor your health.

Please note: Lupus is a vascular disease that can lead to a host of blood-vessel problems. Consequently, it is important for patients to develop a healthy lifestyle that incorporates regular exercise and "heart-healthy" diets. However, there are no specific dietary interventions that alter the activity of lupus itself.

A Rich Tradition in Research & Clinical Care

The Rheumatology Unit has a rich tradition of research and clinical care in lupus. Marian Ropes, MD (1903-1994), one of the premier rheumatologists of her time, wrote an extensive monograph on lupus in the 1970s and helped formulate the first diagnostic criteria for the disease.

Another world-renowned rheumatologist, John Mills, MD, wrote extensively on the clinical features of lupus and helped train generations of clinicians before his retirement in 2010.

Today, investigators in the Division of Rheumatology, Allergy, & Immunology Clinical Epidemiology Program are investigating ways to improve lupus clinical outcomes and striving to find the safest and most effective ways to treat lupus. Additionally, collaborations between investigators in our unit and scientists in the Center for Immunology and Inflammatory Diseases (CIID) are making progress in understanding immune dysregulation in lupus. We expect the findings will lead to safer, more effective treatments for the condition.

Our Current Research

April Jorge, MD, the Director of the Lupus Program, and other Mass General experts are advancing the field of lupus through a wide variety of innovative research studies, including clinical trials, observational studies, clinical epidemiology, focus groups/survey research, and translational studies to discover new approaches to diagnosing and managing lupus. For more information, please contact LupusResearch@mgh.harvard.edu.

Currently enrolling studies include:

• Study of immune responses in the blood during systemic lupus erythematosus and related autoimmune and inflammatory diseases. This study involves a one-time blood draw. The goal is to better understand immune system dysregulation involved in causing lupus

• Lupus Patient Preferences. This study involves participation in focus group sessions and completion of surveys. The goal is to understand how patients make treatment decisions and weigh the risks and benefits of lupus treatments

• Clinical Trials for promising new lupus treatments. Current studies are available, in conjunction with the the Lupus Clinical Investigators Network (LuCIN) and the NIH Autoimmune Center of Excellence. Browse open clinical trials

Other recent and ongoing studies led by our experts include:

• April Jorge, MD (Director), Hyon Choi, MD, DrPH, and Yuqing Zhang, ScD, led a recent NIH-funded study, "Hydroxychloroquine Dose and Risk for Incident Retinopathy," published in Annals of Internal Medicine that estimated the risk of retinopathy among long-term users of this key medication in lupus care

• April Jorge, MD also led a recent Rheumatology Research Foundation funded study, "Hydroxychloroquine Dose per Ophthalmology Guidelines and the Risk of Systemic Lupus Erythematosus Flares," published in JAMA

• April Jorge, MD and other Clinical Epidemiology Program investigators are conducting clinical epidemiology studies to better understand the risks and risk factors for infection, cardiovascular events, kidney failure, adverse pregnancy outcomes, and other key clinical outcomes for people with lupus

• Division Chief and Director of the Center for Immunology and Inflammatory Diseases, Andrew Luster, MD, PhD, is focused on understanding how the immune system discerns its host from the enemy (an identification process that breaks down in autoimmune diseases such as lupus) and how the innate immune system drives inflammation in lupus

Where to Find More Information

There are many resources to find helpful and reliable information about lupus. Many patients and their families find the book Facing Lupus to be helpful in understanding the disease and its impact on people living with lupus. We also recommend checking out the Lupus Foundation of America website.