Mass General Program One of the Few in the World to Focus on Vasculitis Patients

Vasculitis encompasses a wide range of rare diseases, many of which can have grave consequences for patients. And yet, very few centers in the United States or the world offer comprehensive, multidisciplinary care focused on the needs of this patient population.

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In order to fill this gap, rheumatologists Sebastian Unizony, MD, and Zachary S. Wallace, MD, MSc, founded the Vasculitis Program in the Rheumatology Unit at Massachusetts General Hospital in 2022. The program provides highly individualized care for patients with all types of vasculitis, which comprises over 20 diseases. It also hosts innovative research to improve treatment strategies, with an eye toward minimizing the use of glucocorticoids (e.g., prednisone) and optimizing quality of life.

Multidisciplinary Expertise Enhances Quality of Vasculitis Care

Nine Mass General rheumatologists form the core of the Vasculitis Program. Collectively, they bring expertise in both the most common vasculitides, such as giant cell arteritis (GCA) and ANCA-associated vasculitis, and the rarer types, such as Takayasu arteritis.

The program aims to establish a prompt diagnosis and implement early treatment plans that can induce remission and prevent long-term relapse. For example, it is one of the few centers to offer a fast-track clinic for patients suspected of having GCA. This approach uses tools including temporal artery ultrasound to either diagnose or rule out GCA within just a few days.

The extended vasculitis team also includes a wide range of specialists with expertise in diagnosing and treating manifestations of vasculitis in various organs. Thirty-six collaborators from Mass General, Brigham and Women's Hospital, and Mass Eye and Ear span 14 specialties, including dermatology, neurology, nephrology, radiology, pathology, otolaryngology, and cardiology.

"Proper care of patients with vasculitis requires a multidisciplinary approach," Dr. Unizony says. "Vasculitis can affect every organ in the body, so it's very important to work with colleagues in other subspecialties. Our specialty collaborators have an interest in vasculitis, and they're committed to seeing our patients in a timely manner when we make a referral."

"What you need to manage many of these conditions is a rheumatologist who has expertise in vasculitis and can establish the diagnosis and treatment plan," Dr. Wallace adds. "But you also want to work closely with other specialists to monitor the disease, track progression, manage complications, and use other interventions that might be necessary, such as to treat a blocked vessel from inflammation."

Pushing the Vasculitis Field Forward Through Research

Research is another point of emphasis for the Vasculitis Program. Over the past decade, its faculty have led clinical trials that have transformed the management of vasculitides. For instance, John H. Stone, MD, MPH, and Dr. Unizony headed an international, multi-center study investigating the drug tocilizumab in GCA. In 2017, following the publication of the results in The New England Journal of Medicine, the FDA made tocilizumab the first—and still the only—drug approved specifically to treat the disease.

"Since then, we've done many trials trying to find better treatments for GCA," Dr. Unizony says. "Better treatments mean those that can keep most patients in remission while minimizing the use of prednisone, which is associated with significant side effects."

In partnership with Mass General's Center for Immunology & Inflammatory Diseases, the Vasculitis Program is active in basic, translational, and clinical research. "We're trying to identify and study new treatments, lead clinical trials, discover new biomarkers, and develop new strategies to take care of patients with vasculitis," Dr. Wallace says.

Dr. Wallace highlighted three particularly interesting areas of research that are ongoing:

• Small vessel vasculitis: Using patients' blood samples, investigators are exploring activity in the immune system that could be causing the disease and searching for proteins that might identify patients at risk for relapse. "These sorts of studies will also give us insights into the pathology while helping us understand what's driving the disease and identify new targets for therapy," Dr. Wallace notes.
• ANCA vasculitis: The Vasculitis Program follows a large cohort of patients with ANCA vasculitis at Mass General, including through a patient registry. Investigators leverage advanced epidemiologic techniques in an effort to pinpoint factors that are associated with either better or worse disease outcomes, which could inform the management of these patients.
• Mind-body intervention: As a sign of its holistic approach to research, the program is developing a novel mind-body intervention to help patients improve their mental and psychological well-being in the face of the countless uncertainties that come with having vasculitis.

In addition to the ANCA vasculitis registry, the Vasculitis Program is currently enrolling patients in research studies examining subclinical atherosclerosis in ANCA vasculitis, secukinumab for the treatment of GCA and of polymyalgia rheumatica, and longitudinal glucocorticoid toxicity in individuals with rheumatic disease.

Embracing the Challenge of Caring for Vasculitis Patients

Drs. Unizony and Wallace look forward to making further progress in clinical care, research, and the other two key program objectives: medical education and patient advocacy.

"These are potentially serious diseases, and many providers welcome the idea of having vasculitis experts follow these patients," Dr. Unizony says. "Even rheumatologists, especially those in the community, often send vasculitis cases to tertiary centers or other experts. We have a passion for autoimmunity and systemic diseases. We want to see these patients, and we want to help them."

Learn more about the Vasculitis Program

Refer a patient to the Vasculitis Program