There may be a link between rheumatoid arthritis (RA) and hair loss. Certain RA medications such as methotrexate and leflunomide can cause loss of hair. A doctor can recommend treatment modifications or supplements to help with hair loss.
Although RA mainly affects the joints, it is a systemic disease. This means it can affect the entire body.
Prolonged inflammation can harm multiple systems and organs within the body.
This article will take a closer look at the link between RA and hair loss and offer advice for those seeking to treat this symptom.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Some people with RA may experience hair loss as a symptom of the disease. For others, hair loss may be a side effect of RA treatment. However, it is uncommon for hair loss to result from either of these causes.
People who experience hair loss tend to lose only a small amount of hair. The hair is more likely to appear thin in places than to fall out in patches.
However, people who have hereditary pattern baldness may find that certain RA medications trigger or accelerate this type of hair loss.
As a result, males may experience permanent hair loss along the hairline or on the top of the head. Females may experience permanent hair thinning on the front and top of the scalp.
Doctors commonly use two classes of drug to treat RA: disease-modifying antirheumatic drugs (DMARDs) and biologics. Some of the drugs within these two groups can cause hair loss.
DMARDs
Treatment for RA
Methotrexate
Methotrexate is the DMARD that doctors
Doctors first used methotrexate as an anticancer drug. As an RA treatment, it stops the growth of the immune cells that trigger chronic inflammation.
Due to the action of the drug, methotrexate can also stop the growth of cells that support the hair follicles. The base of the hair follicle can then weaken, causing the hair to become loose.
About 1–3% of people who take methotrexate will experience some degree of hair loss.
Methotrexate also depletes the body of the B vitamin folate, which promotes healthy hair.
Leflunomide
Leflunomide is another type of DMARD that many people take in combination with or instead of methotrexate.
Approximately 10% of people experience hair loss as a result of taking leflunomide.
Biologics
Biologics are a genetically engineered group of drugs that originate from living cells. These drugs specifically target parts of the immune system that stimulate inflammation.
Etanercept and adalimumab are two biologic drugs that may cause hair loss.
Experts do not know why this is the case. Some suggest that biologics may disrupt the balance of a type of protein that allows cells to communicate and also plays a role in hair follicle regeneration.
Hair loss of any kind can sometimes be a source of psychological distress. Some people may become depressed, anxious, or socially withdrawn as a result of hair loss.
People who feel this way should see a doctor to discuss modifying their treatment plan, which could help if their medication is the cause of the hair loss.
Certain supplements and hair care practices may also help tackle hair loss.
Supplements
People taking methotrexate or leflunomide may benefit from taking folic acid and biotin supplements. These B vitamins can help protect against hair loss.
Folic acid can also help relieve some of the other side effects that can occur with methotrexate. These include headaches, shortness of breath, and fatigue.
General tips
Other tips that may help minimize hair loss include:
- avoiding scrubbing the scalp when washing the hair
- allowing the hair to dry naturally after showering
- combing the hair only when necessary, such as when styling it or removing tangles
- avoiding pulling or tugging on the hair when brushing or combing
- using a moisturizing conditioner to remove tangles
- avoiding hairstyles that pull on the hair
Most people who experience medication-induced hair loss find that their hair grows back once they stop taking the drug responsible.
People who are concerned about hair loss should speak with a doctor about the possibility of lowering their current medication dosage.
Another option may be to switch to an RA medication that does not list hair loss as a potential side effect. Examples include the following DMARDs:
While these drugs do not cause hair loss, each one has other possible side effects.
People should talk with a doctor about the side effects of each drug. The doctor will be able to offer advice on the most appropriate drug or combination of drugs.
In some cases, hair loss can indicate a serious underlying medical condition that requires urgent attention.
People who experience the following signs and symptoms of hair loss should talk with a doctor or rheumatologist immediately:
- sudden or patchy hair loss
- excessive hair loss when washing or combing the hair
- regularly finding hair on the pillow
People should also see a doctor if they feel particularly concerned or distressed by hair loss.
In some cases, a doctor may make a referral to a dermatologist or hair loss specialist. These professionals can offer advice on potential hair loss treatments.
Hair loss in RA is rare. However, it can occur as a symptom of the disease or as a side effect of RA medications.
In most cases, hair loss is minimal. Hair can regrow once a person stops taking the medication that causes the loss.
People should not stop taking any medication unless a doctor advises them to do so. A doctor can offer advice on alternative medicines and may refer the person to a dermatologist or hair loss specialist if necessary.