Rheumatoid Arthritis and Hair Loss: What’s the Link?

When you think of rheumatoid arthritis, you probably think of aching joints, not changes in your hair. But can rheumatoid arthritis (RA) cause hair loss? The short answer is: yes, rheumatoid arthritis (and medications for it) can potentially cause hair loss, but it’s rare and usually not very severe.

Here, we’ll dive deeper into the link between RA and hair loss, which RA medications may cause hair loss as a side effect (and which don’t), plus how to treat hair loss caused by RA.

Before we dive into RA and hair loss specifically, it’s important to understand RA, a chronic inflammatory condition that causes inflammation in the joints and tissue. It typically affects smaller joints, like those in the fingers and toes.

In some cases, RA can cause your immune system to attack the tissues in your skin, including the area surrounding the hair follicles. Hair loss caused by stress, illness, or injury is known as telogen effluvium, and while possible, it’s rare to have significant hair shedding or hair loss with RA.

However, certain medications you take to alleviate your RA symptoms could potentially cause hair loss.

While hair loss directly caused by rheumatoid arthritis is rare, some medications used to treat RA can cause hair thinning or hair loss.

For example, disease-modifying antirheumatic drugs (DMARDs) are commonly prescribed for RA. They suppress the immune system by stopping cells from growing (including hair follicle cells). This is good for managing the symptoms of autoimmune diseases, but some DMARDs can potentially cause hair loss (though this side effect is rare).

RA medication that can cause hair loss include:

• DMARDs, including methotrexate (Otrexup, Rasuvo) and leflunomide (Arava) — research shows that approximately 10 percent of people taking leflunomide experience hair loss.

• Certain steroids, including prednisone. You can learn more in our guide to steroids and hair loss.

• Certain biologics, including etanercept (Enbrel) and adalimumab (Humira) can cause hair loss.

Does Methotrexate Cause Hair Loss?

Many people also wonder, does methotrexate cause hair loss? And the answer is that it can, but rarely. By some estimates, methotrexate can cause hair loss in one to three percent of cases.

Here’s where it gets tricky, though: Methotrexate is also prescribed to treat alopecia areata, an autoimmune condition that specifically attacks hair follicles, causing patchy hair loss.

In this case, research shows that methotrexate actually helps with hair regrowth, and another study showed that RA patients on a low dose of the medication actually lost less hair in a hair pull test. So while methotrexate can cause hair loss in rare cases, it can also have the opposite effect.

All of this may lead you to a common Google search: How can I stop my hair from falling out from methotrexate? The truth is that it’s hard to prevent hair loss from a medication while you’re still taking it. But if the hair loss is taking a toll on your self-esteem or confidence, speak to your doctor about lowering the dosage or changing medications.

Rheumatoid Arthritis Medications That Are Not Known to Cause Hair Loss

You don’t have to go cold turkey on RA medication to avoid hair loss. Instead, you can speak to your healthcare provider about changing your dosage or switching to an RA medication that is not known to cause hair loss as a potential side effect. These include the following DMARDs:

• Tofacitinib

• Sulfasalazine

• Hydroxychloroquine sulfate

Rheumatoid arthritis (and medication for the condition) typically does not cause drastic hair loss. Instead, you may see gradual overall thinning in certain areas, not patching hair loss.

If you’re noticing major hair loss or balding, it’s probably not the work of RA. But, it’s possible that if you’re experiencing male or female pattern baldness, you may notice that an RA flare-up or medication accelerates your hair loss. If the medication is the culprit in your hair loss, you will typically see normal regrowth once you stop taking it.

Whether your hair loss is caused by RA, medication, another autoimmune disorder, or something else entirely, there are treatment options that can get you on the road to healthy hair.

Minoxidil

You may be more familiar with minoxidil by its brand name, Rogaine®. It’s a vasodilator that brings oxygen and blood flow to the scalp and increases the size of the hair follicles. The bigger the follicle, the thicker the hair.

We offer minoxidil liquid solution and foam, both at 5% strength (which is the sweet spot for hair regrowth). Topical minoxidil is an over-the-counter, FDA-approved product for hair loss.

But oral minoxidil may be an option if you’re not into topical products. It requires a prescription and isn’t FDA-approved specifically for hair loss, but it’s sometimes used off-label to treat hair loss and shedding. Minoxidil in all its forms is a good option for treating hair loss caused by illness or medication.

Finasteride

Finasteride reduces the amount of a male hormone known as dihydrotestosterone (DHT) in the body. DHT is largely responsible for male pattern baldness (androgenetic alopecia). Because it works on a hormonal level, finasteride is not going to be super effective if your hair loss is strictly caused by RA or a medication.

However, if you suspect your hair loss also has a genetic component (so, you’re dealing with good old-fashioned male pattern baldness), finasteride, which is the active ingredient in Propecia®, is an excellent line of defense at both slowing hair loss and helping to boost regrowth.

Hair Loss Shampoo and Conditioner

If you’re dealing with thinning hair and want to give it a little boost, hair loss shampoo and conditioner is a good option that may also help you hold onto the hair you have.

Our thickening shampoo is made with saw palmetto, a plant ingredient that research shows has the potential to slow hair loss.

It’s also a DHT blocker, which might not be ideal for hair loss caused by medication. However, if you believe male pattern baldness is a contributing factor, it’s a good option to consider.

Biotin

Some studies show that people taking methotrexate or leflunomide may benefit from taking certain supplements, including folic acid and biotin, which can help fight hair loss and reduce some of the symptoms of DMARDs.

If you’re interested in supplementing, check out our biotin gummies.

While hair loss from RA is rare, other autoimmune diseases can more commonly cause hair loss. This is especially important to know because research shows that patients with RA are likely to have more than one autoimmune disease.

It’s possible that if you have RA and are seeing hair loss, the shedding is actually from another autoimmune disease.

Other autoimmune disorders that can cause hair loss include:

• Alopecia areata

• Lupus

• Hashimoto's disease

• Graves' disease

• Certain thyroid diseases

• Psoriasis

• Vitiligo

Need a quick recap? Here’s the TL;DR on RA and hair loss.

• RA happens when your immune system attacks tissue surrounding your joints, but it can also potentially attack tissue in other areas of your body, including the tissue around hair follicles. While uncommon, RA is a possible cause of hair loss, and certain medications can be used to treat it.

• Patients experiencing hair loss due to RA medications have various options, including switching to medications less likely to cause hair loss, such as tofacitinib and hydroxychloroquine sulfate, or using treatments like minoxidil and biotin supplements to promote hair regrowth.

• It’s always a good idea for RA patients to discuss any concerns about hair loss with their healthcare providers or dermatologists to explore alternative hair loss treatments or adjust medication dosages. This can help manage both RA symptoms and maintain healthy hair.

To learn more about potential causes of thinning hair, check out our guide to illnesses that cause hair loss. If you’re ready to take the next step to stopping hair loss, you can check out our hair loss treatment options available online, following a virtual consultation with one of our licensed healthcare professionals.