If you have rheumatoid arthritis (RA) and are noticing hair loss, you may be wondering what’s causing it. Hair loss is not a direct symptom of RA, but it can be linked to inflammation, medications, or another health condition that happens at the same time.

Keep reading to learn how RA may be connected to hair loss and whether your alopecia is a side effect of your medication.

Types of Hair Loss Related to Rheumatoid Arthritis

Hair loss isn’t a direct symptom of RA, but RA has been linked to certain types, including alopecia areata, medication-related hair loss, and telogen effluvium. Here’s what we know.

Alopecia Areata

Alopecia areata and RA are both autoimmune diseases. That means the immune system mistakenly attacks healthy tissues in the body. In alopecia areata, the immune system targets the hair follicles. In RA, the immune system mainly attacks the joints, but the disease can also affect other parts of the body. People with alopecia areata develop patchy, unpredictable hair loss. Some people have small bald patches that grow back and never fall out again, while others may experience hair loss on many parts of the body.

Researchers believe that having one autoimmune disease increases the odds of developing another. If you have RA, you may have a higher risk of developing alopecia areata, especially if your hair loss started between the ages of 20 and 40. The two conditions can occur together, but it’s not common.

Medication-Related Hair Loss

Disease-modifying antirheumatic drugs (DMARDs) are commonly prescribed to people with autoimmune diseases. They help calm the immune system and relieve symptoms, like pain or inflammation. Sometimes, people experience hair loss while taking them. Hair usually grows back after stopping the medication (with a doctor’s approval).

Doctors often prescribe a type of DMARD called methotrexate for people with RA, but methotrexate can cause side effects like nausea or a skin rash. Between 1 percent and 3 percent of people taking methotrexate experience hair loss, although some research suggests this happens in those taking high doses.

DMARDs usually cause extra shedding, not bald spots. In rare cases, methotrexate has been linked to more severe but temporary hair loss called anagen effluvium. This is the same kind of hair loss often seen during chemotherapy.

Leflunomide is another DMARD used to treat RA. It can cause hair loss in up to 10 percent of people taking it, but it’s not as commonly prescribed.

Telogen Effluvium

Telogen effluvium is a type of hair loss that causes temporary hair thinning in response to a trigger, like illness or a change in the body.

Some aspects of RA can also trigger telogen effluvium. These may include:

• Stress — Managing painful joints and mobility challenges can be stressful. The emotional toll can cause hair loss.
• Fever — Some people with RA may have consistent low-grade fevers from inflammation throughout the body. A fever is a common trigger for temporary hair loss.
• Surgery — Those with severe joint damage may need surgery, like a hip or knee replacement. Surgeries are stressful to the body and may cause hair loss.

Hair Loss From Medication vs. Alopecia Areata

Medication-related hair loss usually looks different from alopecia areata. There are three major differences between the two: hair loss patterns, timing, and associated symptoms.

• Hair loss patterns — Alopecia areata causes patchy hair loss on the scalp, beard, eyelashes, eyebrows, or entire body. Medication-related hair loss is usually generalized shedding across the scalp without defined bald spots.
• Timing — Medication-related hair loss is often tied to when you start the medication, and hair regrows when you stop it. Alopecia areata is hard to predict and may still continue even after possible triggers are removed.
• Associated symptoms — About 10 percent to 20 percent of people with alopecia areata develop rough, brittle, ridged nails alongside their hair loss. Medication-related hair loss doesn’t usually have other symptoms, but you may see other treatment side effects.

Other Causes of Hair Loss

Although medications and stress may cause hair loss, it’s important to talk to your doctor about other conditions that may be affecting your hair health. It’s possible to have RA alongside another health issue that’s responsible for your symptoms.

Below are a few conditions your doctor may consider as causes of your hair loss.

Thyroid Disease

As mentioned earlier, having one autoimmune disease increases the likelihood of having another, like alopecia areata. Your doctor may also want to rule out other autoimmune causes of hair loss, including thyroid disease, one of the most common culprits.

Your thyroid controls how your body uses energy and other important functions, like body temperature and heart rate. An overactive immune system can affect thyroid cells, leading to a range of symptoms, including hair loss. It can either lower thyroid activity (called hypothyroidism, or Hashimoto’s disease) or heighten thyroid activity (called hyperthyroidism, or Graves’ disease).

Nutritional Deficiency

People with RA may be at higher risk of not having enough vitamins and minerals. This may be caused by metabolic changes from long-term inflammation or certain medications (like methotrexate).

Common deficiencies related to RA include folic acid, vitamin C, vitamin D, vitamin B6, vitamin B12, vitamin E, calcium, magnesium, zinc, and selenium. One study also suggests that people with RA may be at risk of developing iron-deficiency anemia (a lack of iron in the body).

While all these nutrients are important for overall health, those that can contribute to hair health include:

• Vitamin C
• Vitamin D
• Vitamin B12
• Iron
• Zinc
• Selenium

Hormonal Changes

Per Cleveland Clinic, women are three times more likely to develop RA than men, and most develop the condition between ages 30 and 60.

These ages also overlap with childbearing, perimenopause, menopause, and postmenopause, all of which involve major hormonal changes. Sudden hormonal changes can trigger hair shedding.

Other Stressors

Life stressors can trigger hair shedding, but it often happens a few months later. Losing a job or a loved one can be an emotional event that stresses the body.

Your doctor may ask when the stress happened and when you noticed the hair loss. If you noticed increased shedding several months after the event, the stress associated with it may be the reason.

What To Do if You Notice Hair Loss

If you notice hair loss, tracking your symptoms can help you and your doctor understand what’s causing it. Here’s what you may want to note:

• When hair loss began
• What patterns, like patches or random shedding, you notice
• How much hair you’re losing
• Where you notice hair loss
• When you started or stopped medications
• Whether you have new or changing symptoms related or unrelated to RA

Your doctor may refer you to a dermatologist for more testing, including skin or blood tests. Once your health team has found the cause, your doctor may suggest several treatment options, like:

• Adjusting your medications to avoid or lessen hair loss, better control your RA, or treat you for another health condition
• Starting a new medication to treat hair loss directly
• Referring you to a dietitian who can help you with a nutrition plan
• Referring you to a mental health specialist who can help you manage your stress
• Looking into cosmetic solutions, like false eyelashes and wigs

Do not start supplements or stop any medications without discussing your treatment with a doctor first.

The Bottom Line

Hair loss with RA can have more than one cause, including medication side effects, alopecia areata, stress, or another health condition. Because treatment depends on the cause, talk with your doctor if you notice thinning, shedding, or bald patches. A proper evaluation can help show what may be causing your hair loss and what might help.

Join the Conversation

On MyAlopeciaTeam, people share their experiences with alopecia, get advice, and find support from others who understand.

Have you noticed hair loss while managing your rheumatoid arthritis? Let others know in the comments below.