Erik: 54 Year Old Male Presents for a Second Opinion on His RA Treatment

Elena Massarotti, MD, practices general rheumatology in the rheumatology division of the Brigham and Women's Hospital, which is a large, full service, tertiary care referral center and a major teaching hospital of Harvard Medical School. This is largely a referral-based practice, comprised of patients referred by primary care physicians, other sub-specialists, and other rheumatologists practicing in the northeastern United States. Dr. Massarotti provides consultation to patients presenting with complex clinical problems, including patients with challenging diagnoses.

In Dr. Massarotti's previous role as the clinical director of rheumatology at Tufts New England Medical Center, she was regarded as the senior clinical rheumatologist and oversaw the clinical care delivered in the clinic along with the division chief who identified and managed quality assurance goals (e.g. tracking of adverse events related to joint injections, patient educational materials for new medications) and instituted policies directed at enhancing patient care (e.g. prepared medication information sheets for patients). In 1998, Dr. Massarotti established the annual Merrill Lecture in Clinical Rheumatology at Tufts New England Medical Center with donated funds. This lectureship honored the clinical and translational contributions of outstanding rheumatologists, and was widely attended by the northeastern rheumatology community. In 2000, under the leadership of Dr. Allen Steere (the division chief of rheumatology at Tufts New England Medical Center at that time) Dr. Massarotti helped to design the new outpatient Itzhak Perlman Family Arthritis Treatment Center at Tufts-NEMC, which was a new clinic focused exclusively for patients with rheumatic diseases. From 2000-2003, Dr. Massarotti established "Patient Care Forums", which were faculty led patient seminars that focused on common rheumatic issues and were held during evening hours for patients and family members to attend. Beginning in 2004, Dr. Massarotti helped develop and grow a clinical trials program in the division of rheumatology.

Dr. Vivian Bykerk received both her BSc and Medical degrees from McMaster University in Ontario, Canada, where she also began her residency in internal medicine. She completed this along with a fellowship in critical care medicine at the University of Toronto, and then went on to complete her fellowship at McGill University in Montreal, Quebec, Canada.

Through the years, Dr. Bykerk has been involved in a vast variety and number of extramural professional responsibilities including reviewing & editorial positions, as well as administration, committee, and research positions both at national and international levels.

Currently, Dr. Bykerk is an Associate Attending Physician and Director of the Inflammatory Arthritis Center at the Hospital for Special Surgery, and an Associate Professor of Medicine at Weill Cornell Medical College. Over the past 15 years, Dr. Bykerk has participated in many clinical trials testing new and emerging therapies in rheumatoid arthritis (RA) to include; randomized trials of new agents for the treatment of RA as well as observational studies to confirm real world effectiveness and safety of approved agents.

Today, Dr. Bykerk's primary area of research and knowledge translation focuses on the early diagnosis of RA and optimization of the treatment of early and established RA to ensure the best outcomes for patients.  Dr. Bykerk has participated and helped design randomized controlled trials and long term observational studies evaluating real world remission rates in RA. In particular, Dr. Bykerk is serving as the principle investigator of a multicenter inception cohort study of 2400 patients with early inflammatory and rheumatoid arthritis, initiated in 2006.  Additionally, Dr. Bykerk is on the steering committee of the Outcomes Measures in Rheumatology Clinical Trials (OMERACT) Flare group, working with a group of international investigators, to develop a measure of Flare in RA.

Moving forward, Dr. Bykerk is in the process of initiating a large multicenter inception cohort study of patients with new onset RA in the United States. The study will focus on predictors of prognosis to optimize patient outcomes and will provide the infrastructure to test decision aids for patients living with and clinicians treating early RA, while incorporating information from emerging biomarkers.

Jonathan Kay, MD, received his medical degree from the University of California School of Medicine in San Francisco, California. He then completed an internship and residency at the Hospital of the University of Pennsylvania in Philadelphia and fellowships in rheumatology and immunology at The Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts.

Dr. Kay is Professor of Medicine at the University of Massachusetts Medical School and a Physician at UMass Memorial Medical Center in Worcester, where he directs Clinical Research in the Division of Rheumatology.

Dr. Kay is a Fellow of the American College of Rheumatology and of the American College of Physicians. He is an ad hoc reviewer for many journals and a member of the editorial boards of Arthritis Care & Research, Best Practice and Research Clinical Rheumatology, and the Journal of Clinical Rheumatology.  

Dr. Kay's clinical interests span the spectrum of rheumatic diseases, with special interest in rheumatoid arthritis and other forms of inflammatory arthritis.  He was a member of the group that developed the 2010 ACR/EULAR Diagnostic and Classification Criteria for Rheumatoid Arthritis. He chairs the Rheumatology Working Group and is a member of the Internal Medicine and Musculoskeletal Topic Advisory Groups for the World Health Organization in its Revision of the International Classification of Diseases (ICD)-11.

He has been a principal investigator on over 40 clinical trials of novel therapies for rheumatoid arthritis, ankylosing spondylitis, gout, and osteoarthritis. Over the past two decades, his clinical research has focused on nephrogenic systemic fibrosis (formerly known as nephrogenic fibrosing dermopathy), beta2-microglobulin amyloidosis, and other rheumatologic problems of patients with chronic kidney disease. Dr. Kay lectures internationally and is the author of more than 100 publications and book chapters.