Rheumatoid arthritis – a systemic autoimmune disease affecting the joints – has been reported to cause hair loss. 

Hair loss can occur as a symptom of the disease. However, many times, it’s the treatment for rheumatoid arthritis that ends up causing drug-induced alopecia. 

Nevertheless, rheumatoid arthritis may also cause indirect hair loss in other ways. And, unfortunately, it might not always be temporary. 

But depending on the kind of hair loss you’ve experienced, you might be able to grow your hair back. In this guide, you’ll learn more about rheumatoid arthritis hair loss and what you can do about it. 

Does Rheumatoid Arthritis Cause Hair Loss?

In rheumatoid arthritis (RA), your immune system may mistakenly attack the hair follicles on your skin, resulting in hair loss. 

Remember that rheumatoid arthritis is a chronic condition that causes inflammation in the affected areas. And inflammation itself can cause hair loss.

This disease doesn’t develop suddenly. In fact, its symptoms can develop over weeks and even months. 

As it progresses, it causes inflammation of the lining of the joints. It can further go on to damage the cartilage and bone until, eventually, the joints stop working.

Other than hair loss (which is rare), however, it can also cause other symptoms, some of which are: 

• Stiff and painful joints
• Swollen, tender, and hot joints
• Weight loss or gain 
• Lack of energy 
• Fever
• Fatigue 
• Dry eyes and mouth
• Shortness of breath  

It can affect other organs in the body, including the lungs, nerves, eyes, heart, and skin. You can even experience a flare, during which the symptoms can worsen. This can also cause hair loss. 

However, aside from the condition itself, hair loss in rheumatoid arthritis can occur indirectly due to its medication. It’s not so common either, but it can still happen. 

Hair loss can be diffuse (occurring all over the scalp) or localised (only affecting specific areas). It can also be temporary or permanent. But usually, it’s said that the hair loss is diffuse and not so significant. 

How Does Rheumatoid Arthritis Cause Hair Loss? 

Let’s take a closer look at the ways in which rheumatoid arthritis can affect the hair follicles on your scalp and body. 

Side Effect Of Drugs 

One of the more common causes of hair loss in rheumatoid arthritis is its treatment. More specifically, it’s the drugs that are used to manage its symptoms. These include: 

• Disease-modifying anti-rheumatic drugs (DMARDs).
• Biologics (a subset of DMARDs) 
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Steroids

Keep in mind that even starting medication can shock the system and result in a type of hair loss known as telogen effluvium. 

And according to the Arthritis Foundation, the medication for arthritis can “trigger or accelerate” pattern baldness in men and women. As you may know, this kind of hair loss is permanent. 

DMARDs 

More commonly, DMARDs are implicated in causing rheumatoid arthritis hair loss.

Among that class of drugs, methotrexate – an immunosuppressant with anti-inflammatory effects – can cause hair loss. In fact, it causes hair loss in as much as 3% of people who’re on this medication. 

Leflunomide is another DMARD that can also cause hair loss. According to the Arthritis Foundation, 10% of the people taking this medication experience hair loss because of it.

Hydroxychloroquine is another drug for rheumatoid arthritis that can result in hair loss. 

Keep in mind that not all DMARDs cause hair loss. For instance, sulfasalazine should not cause thinning. Still, it’s important to ask your doctor if hair loss is a potential side effect of the drug you’re taking. 

Here, it should also be noted that DMARDs can also increase the risk of bacterial, viral and fungal infections, which can also cause hair loss.  

Biologics

Biologics used in the treatment of rheumatoid arthritis can also cause hair loss. Some examples include: 

• Etanercept
• Adalimumab
• Infliximab
• Certolizumab 
• Rituximab

These drugs have been reported to cause serious hair loss. For instance, certolizumab can result in alopecia totalis. It’s a type of alopecia areata that can cause complete hair loss on the entire scalp. 

TNF inhibitors (which include some of the drugs listed above) are also biologics that can induce or even worsen alopecia areata. 

NSAIDs

Nonsteroidal anti-inflammatory drugs may also be the reason behind your excessive shedding. 

NSAIDs like ibuprofen, naproxen, and sulindac, among others, for instance, can cause hair loss. 

This type of hair loss may be just because of telogen effluvium. 

Steroids 

Certain steroids can cause hair loss as a side effect. 

For the corticosteroid, prednisolone, the FDA lists “thinning scalp hair” as one of the adverse reactions of the drugs. 

And this drug has also been used in the treatment of rheumatoid arthritis. 

Coexisting Illnesses 

People with rheumatoid arthritis are at a higher risk of developing certain other illnesses. 

A study published in Mayo Clinic Proceedings found that rheumatoid arthritis can put people at a higher risk of developing heart disease, blood clots, and sleep apnea. 

The same study also found that type 1 diabetes or inflammatory bowel disease can also increase the risk of rheumatoid arthritis. 

These comorbid conditions can also be responsible for hair loss. 

Other than that, a nationwide study in Taiwan, published in Frontiers in Medicine, showed that people with rheumatoid arthritis are at a higher risk of developing the autoimmune alopecia areata. 

A type of permanent scarring alopecia called frontal fibrosing alopecia also occurs commonly in rheumatoid arthritis patients, according to DermNet. 

Nutritional Deficiency

Different vitamin and mineral deficiencies have been noted in those with rheumatoid arthritis. John Hopkins Arthritis Center reports the following: 

• Vitamin B (6, 9 and 12), C, D, and E 
• Calcium 
• Magnesium 
• Zinc 
• Selenium 

These nutrients play an important role in the growth and development of hair. And if sufficient amounts are not being consumed, it can also cause hair loss. 

Many people with rheumatoid arthritis also develop anaemia. And with that, your hair might not get enough oxygen to grow normally. 

Stress

Rheumatoid arthritis can cause depression and anxiety. Because of the very serious symptoms of this condition, it can be especially hard to live with (physically and mentally). 

The stress of it can end up causing hair loss in different ways. It can trigger alopecia areata. It can make you want to pluck your hair out (trichotillomania). Or it can cause telogen effluvium. 

How To Stop Rheumatoid Arthritis Hair Loss?

The treatment for hair loss caused by rheumatoid arthritis will depend on the underlying cause of hair loss. 

If your medication is causing hair loss, your doctor might switch you to a different medication. Although, do not discontinue a drug without consulting your doctor first.

Your doctor might also recommend you take certain supplements. For example, folic acid supplementation can reduce the risk of hair loss caused by methotrexate. It may even help you prevent rheumatoid arthritis hair loss.

Moreover, supplements may also be helpful if you have a deficiency. But you should consult your doctor before taking them. 

On your end, it’s important to have a healthy diet. The right foods can even help with the inflammation caused by this condition. 

Moreover, you should consider looking for ways to manage your stress. Exercising, meditation, deep breathing, and yoga are a few things that can help. 

And lastly, make sure to be gentle with your hair. Tight hairstyles, over-styling, dyeing, etc., may just make things worse. 

Is Rheumatoid Arthritis Hair Loss Reversible? 

Whether or not rheumatoid arthritis hair loss is reversible depends on its underlying cause. 

Usually, drug-induced alopecia is reversible. However, if somehow rheumatoid arthritis has led to the development of pattern baldness, that hair loss will be permanent. 

Similarly, the frontal fibrosing alopecia associated with it permanently destroys the hair follicles. So that’s also irreversible. 

Hair loss resulting from stress, however, is usually reversible as well. 

Conclusion

Rheumatoid arthritis is a long-term condition that has no cure. There can also be unpredictable episodes (flares) of it. In all that, other than affecting the joints, it can also cause hair loss. 

It’s not always direct, though. It can also occur indirectly as a result of medications, coexisting illnesses, nutritional deficiency and stress. But depending on the type of hair loss you have, it may be possible to reverse it. 

So, if you’re losing an abnormal amount of hair, make sure to get in touch with a board-certified medical professional for a diagnosis and treatment plan. 

Reviewed and Approved by Trichologist Yaprak Yazan