People with rheumatoid arthritis (RA) may experience hair thinning or loss. While RA itself rarely causes significant baldness, medications used to treat the disease, other autoimmune conditions, and stress are common contributors.
Causes of Hair Loss in RA
Medications
Hair thinning is often linked to RA treatments, particularly disease-modifying antirheumatic drugs (DMARDs).
Methotrexate: This widely prescribed DMARD interferes with inflammation pathways and slows cell growth, which can disrupt hair follicle function. Studies suggest around 9% of users experience mild thinning.
Leflunomide (Arava): Another DMARD, it causes hair loss in about 10% of patients.
Biologics: Targeted DMARDs, such as anti-TNF therapies (etanercept, adalimumab, infliximab), may lead to hair loss in roughly 3% of women with RA.
Other Autoimmune Conditions
RA increases the risk of additional autoimmune disorders, some of which can trigger hair loss:
Alopecia Areata: This condition attacks hair follicles, causing patchy baldness. Around 4% of those with alopecia areata also have RA. Severe RA may increase the likelihood of developing this condition.
Thyroid Disease: Autoimmune thyroid disorders like Hashimoto’s or Graves’ disease are more common in RA patients and are linked to hair thinning.
Lupus: Up to 15% of RA patients show multiple lupus symptoms. Hair loss affects nearly half of lupus patients and can be worsened by medications or scalp rashes associated with the disease.
Stress
Chronic stress from managing RA can trigger telogen effluvium, a temporary condition where hair prematurely enters the resting phase and falls out. Recovery may take up to six months.
The Disease Itself
In rare cases, RA-related inflammation may affect tissue around hair follicles, leading to minor thinning.
Remedies and Management
If hair loss occurs, consulting a doctor is the first step. They will assess possible causes, including medication changes, and may test for other autoimmune conditions.
Medication Adjustments
Folic Acid Supplements: DMARDs like methotrexate interfere with folate. A daily 1 mg supplement can reduce hair loss and gastrointestinal symptoms, with doses increased to 2–3 mg if thinning occurs.
Switching Medications: If hair loss is severe, doctors may consider changing the DMARD. This requires balancing RA control with potential side effects.
Dermatological Treatments
A dermatologist may recommend treatments such as minoxidil for direct hair regrowth.
Stress Management
Reducing stress can improve hair health and overall RA symptoms:
Therapy: Professional support can help manage pain, sleep issues, and mood.
Exercise: Physical activity eases joint stiffness and stress.
Relaxation Techniques: Meditation, deep breathing, or brief mindful exercises can reduce stress over time.
While hair loss in RA is often mild, addressing medications, stress, and underlying autoimmune conditions can help manage thinning and improve overall well-being.
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