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Rheumatoid arthritis is a type of autoimmune disease. The body’s immune system mistakenly attacks the joints, causing pain, inflammation, and reduced joint mobility. In some people, the condition may also lead to hair loss.

Although rheumatoid arthritis (RA) mainly affects the joints, it is a systemic disease, meaning that it can affect the entire body. Prolonged inflammation can harm multiple systems and organs within the body.

In this article, we look at the link between RA and hair loss and offer advice for those seeking to treat this symptom.

Does RA cause hair loss?

Hair brush with hair in it. It is rare for people to experience hair loss as a symptom of RA.
It is rare for people to experience hair loss as a symptom of RA.

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 rare for hair loss to result from either of these causes.

People who do 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.


RA medications and hair loss

Two classes of drugs that doctors commonly use to treat RA are disease modifying antirheumatic drugs (DMARDs) and biologics. Some of the drugs within these two groups can cause hair loss.

DMARDS

DMARDs are the most common treatment for RA. These drugs suppress the immune system, thereby reducing chronic inflammation.

Methotrexate

Methotrexate is the DMARD that doctors most commonly prescribe for RA. This drug works by stopping the growth of the body’s cells.

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.

Treating hair loss

Blister pack of folic acid tablets.
Folic acid may help relieve the side effects of some RA treatments.

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 a change of medication, 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.

Folic acid supplements are available to purchase online.

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


RA medications that do not cause hair loss

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 to their 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:

  • tofacitinib
  • mycophenolate mofetil
  • sulfasalazine
  • hydroxychloroquine sulfate

While these drugs do not cause hair loss, each one has other possible side effects.

People should talk to 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.

When to see a doctor

Doctor speaking to patient.
People should speak to a doctor if they experience sudden or excessive hair loss.

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 to their 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.


Summary

Hair loss in RA is rare, but it can occur as a symptom of the disease or as a side effect of RA medications.

In most cases, hair loss is minimal, and hair can regrow once a person stops taking the medication responsible.

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.

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