Does Rheumatoid Arthritis Cause Hair Loss?

When you think of rheumatoid arthritis, you probably think of aching joints, not changes in your hair.

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.

But it’s more likely that your hair loss is caused by factors relating to your RA, such as stress. In that case, your hair loss is known as telogen effluvium.

While possible, it’s rare to have significant hair shedding or hair loss with RA. However, certain medications you take to alleviate RA symptoms could potentially cause hair loss.

Hair loss or hair thinning linked to rheumatoid arthritis medications is a known—but uncommon—side effect, often tied to how these drugs interact with cell growth and the immune system.

While they’re effective in managing RA symptoms, some of these medications can interfere with normal hair follicle function, leading to hair thinning or shedding in some people.

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—which are pretty important for growing hair.

This is good for managing the symptoms of autoimmune diseases like RA, but some DMARDs may cause hair loss (though this side effect is rare).

RA medication that can play a role in hair loss include:

• DMARDs, including methotrexate (Otrexup, Rasuvo) and leflunomide (Arava)

• Certain steroids, including prednisone

• Certain biologics, including etanercept (Enbrel) and adalimumab (Humira)

Let’s take a closer look at how these may be involved in hair loss.

Methotrexate

Many people wonder: Does methotrexate cause hair loss? The answer is that it can, but rarely. By some estimates, methotrexate can cause hair loss in 1 to 3 percent of people.

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. In fact, in one preliminary 2019 study (that was only presented, not yet published), RA patients on a low dose of the medication actually lost less hair than people who didn’t have RA in a hair pull test.

So, while methotrexate hair loss can occur in rare cases, it can also have the opposite effect.

All of this may lead you to a natural question: How can I stop my hair from falling out from methotrexate?

The truth is 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.

Leflunomide

Another DMARD, leflunomide, is associated with a higher prevalence of hair loss than methotrexate. Around 10 percent of users may experience hair loss.

Leflunomide reduces inflammation by suppressing the production of new immune cells that could otherwise contribute to inflammation.

What’s the link between leflunomide and hair loss? It can inadvertently affect your hair follicle cells, leading to slower hair growth or increased shedding.

People taking leflunomide (or methotrexate) who are experiencing significant hair loss may benefit from folate or biotin supplementation to potentially help mitigate some of these unwanted hair effects, according to older research.

Corticosteroids

Corticosteroids like prednisone are often used to control inflammation during RA flare-ups.

While these medications can help manage joint pain and swelling, they may also disrupt your normal hair growth cycle, leading to more hair loss.

Prolonged use of steroids can lead to telogen effluvium, a condition where more hair follicles enter the resting (telogen) phase, resulting in thinning.

The good news? Hair loss caused by corticosteroids is usually reversible once the medication is tapered off or discontinued.

Biologics

Biologic DMARDs, such as etanercept (Enbrel) and adalimumab (Humira), target specific pathways in the immune system to reduce inflammation.

While generally less likely to cause hair loss than traditional DMARDs, these medications have been reported to contribute to hair shedding in rare cases.

The exact mechanism is unclear, but it may involve alopecia areata, an overactive immune response in some individuals, causing unintended effects on hair follicles.

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 treatment options:

• Tofacitinib (Xeljanz), a Janus kinase (JAK) inhibitor, which can be used to treat hair loss in people with alopecia areata

• Sulfasalazine

• Hydroxychloroquine

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 due to 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, meaning it helps open up your blood vessels. Better blood flow brings oxygen 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 percent 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 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. Oral finasteride has been FDA-approved for more than 25 years.

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 are good hair care options 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 people taking methotrexate or leflunomide may benefit from taking certain supplements, including folic acid and biotin, which may help fight hair loss caused by 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 people 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

• Certain thyroid diseases

• Psoriasis

• Vitiligo

Rheumatoid arthritis 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 options, including switching to medications less likely to cause hair loss, such as tofacitinib and hydroxychloroquine, or using treatments like minoxidil and biotin supplements to promote hair regrowth.

It’s always a good idea to discuss any concerns about hair loss with your healthcare provider or dermatologist to explore alternative hair loss treatments or adjust medication dosages. This can help manage both RA symptoms and maintain healthy hair.

If you’re ready to take the next step to stop hair loss, check out our hair loss treatment options, following a virtual consultation with one of our licensed healthcare professionals.