Rheumatoid Arthritis: Understanding the Causes and Remedies for Hair Loss

Rheumatoid Arthritis and Hair Loss: Causes and Remedies

Rheumatoid Arthritis and Hair Loss: Causes and Remedies
Marina Demeshko/iStock
By
Published on December 9, 2025
by

People with rheumatoid arthritis (RA) may experience hair loss or thinning, though it’s not usually caused by the disease but by medications used to treat RA.

Sometimes people with RA have other autoimmune diseases that can cause hair loss. In rare cases, the inflammation and autoimmune activity of RA itself can affect the hair follicles, leading to minor hair thinning or loss.

In most people, the hair thinning is usually mild and doesn’t lead to noticeable balding. In some cases, alopecia areata can cause patches of baldness.

Since hair loss also occurs with age, it can be hard to tell if hair loss is normal or related to RA. Here are the main causes of hair loss in RA and what to do if you notice that you’re losing hair faster than normal.

Medications for RA

Certain medications commonly used to treat RA are the main cause of hair thinning. If you recently started a new medication or changed a dosage and you notice hair on your pillow in the morning or excess hair in the shower, it’s likely caused by the medication. RA medications that may cause hair thinning include these types.

Disease-Modifying Antirheumatic Drugs (DMARDs) The biggest culprits are DMARDs, which are the most commonly used medications to treat RA. DMARDs such as methotrexate work by interfering with inflammation pathways. But they also slow cell growth and block cells’ access to folate, or folic acid.

“This disrupts the normal function of hair follicles and causes diffuse thinning rather than complete baldness,” says John Davis, MD, a rheumatologist at Mayo Clinic in Rochester, Minnesota. It’s not clear why some people experience thinning while others don’t, but it may be related to how different people metabolize folate.

  • Methotrexate is the first medication physicians usually prescribe to treat RA. Studies vary as to how common hair thinning is in people who take methotrexate, but at least one has shown the rate to be about 9 percent.

  • Leflunomide (Arava) is another commonly used DMARD that comes with a higher risk of hair loss, occurring in about 1 in 10 people.

Biologics These are DMARDs made from biological organisms, and they target more specific areas of the immune system. They are sometimes taken in combination with traditional DMARDs. One study found that 3.3 percent of the women with rheumatic diseases including RA who took the anti-TNF therapies etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) experienced hair loss.

Other Autoimmune Diseases

People with one autoimmune disease, like RA, are at a higher risk of having others, and some autoimmune diseases come with an increased risk of hair loss. If you experience hair loss, you may want to get tested for these conditions.

Alopecia Areata This autoimmune disease specifically targets hair follicles. It causes telltale patches of hair loss. About 4 percent of people with alopecia areata also have RA.

 Studies suggest that people with RA have an increased risk of alopecia areata and that RA can trigger alopecia areata. The more severe the RA, the higher the risk of developing alopecia areata.

Thyroid Disease People with RA have more than double the risk of having thyroid disease, particularly autoimmune thyroid conditions like Hashimoto's and Graves' disease.

 Thyroid disease comes with an increased risk of hair loss, and it also has a strong connection with alopecia areata.

Lupus People with RA have an increased risk of also having lupus, another autoimmune disease. Some of the symptoms of lupus can overlap with those of RA, like joint pain, but other symptoms are unique to lupus. One study found that 15 percent of people with RA had at least four symptoms of lupus, aside from joint pain.

 Hair loss is extremely common in people with lupus, affecting almost half of people with the illness. Lupus can cause skin issues like rashes and sores on the scalp, which can lead to hair loss. And certain medications for lupus can also cause hair loss.

Stress

The constant emotional stress of living with a chronic condition like RA and the physical stress of a flare-up can trigger a temporary form of hair loss called telogen effluvium. This is when a large number of hairs prematurely shift from the growing phase to the resting phase and then fall out a few months later. Though the hair loss is temporary, it could take up to six months for hair to grow back.

The Disease Itself

In rare cases, the inflammation and autoimmune activity of RA can affect tissues surrounding the hair follicles, leading to minor hair thinning or loss.

Hair Loss Remedies for Rheumatoid Arthritis

If you notice hair loss, speak to your doctor, says Dr. Davis. The first thing they’ll do is consider the different causes for the hair loss. They will likely see if the hair loss is related to any new medications you’re taking or a change in your dosage. They may recommend testing for other autoimmune diseases that can cause hair loss. If you have another autoimmune disease, treating that illness may also help with hair loss.

If you’re taking a DMARD, doctors typically recommend that you take 1 milligram (mg) daily of folic acid (folate) because the drug interferes with the effects of folate. A folic acid supplement can help prevent hair loss and gastrointestinal symptoms. If you start to experience hair loss while on a DMARD, your dose can be increased to 2 to 3 mg a day, says Davis.

If the hair loss is significant or distressing, you can talk to your doctor about changing the medication.

“Controlling RA is very important, and there are possible upsides and downsides to stopping the DMARD and switching to something else,” says Davis. A different DMARD may affect you differently, so you need to weigh the benefits and potential side effects of each medication. “My sense is that patients choose to switch medications only when the hair loss is pretty disruptive for them,” says Davis.

If switching medications isn’t possible, your doctor may refer you to a dermatologist, who can recommend treatments that directly address hair loss, such as minoxidil.

It may also be helpful to find ways to manage your stress, and this may help with other symptoms as well. Some options for managing stress include the following:

Talk to a therapist. A therapist can help cope with pain, sleep, and mood issues that may be related to your RA.

Make sure your RA is being treated. If your symptoms aren’t well managed, it can lead to more pain, less sleep, and more stress. Talk to your doctor if you’re not seeing improvements with your current medications.

Exercise. Exercising can help ease joint pain and stiffness, and it can help relieve stress.

Learn relaxation techniques. Any type of breathing or meditative exercise, even if you do it for just a few minutes, can help reduce your overall stress. And the more you do it, the more helpful it becomes.

The Takeaway

  • Hair loss associated with rheumatoid arthritis is generally mild and can be caused by RA medications, especially DMARDs.
  • To counteract potential hair thinning from medications, including methotrexate, healthcare providers often recommend taking a daily folic acid supplement.
  • Finding ways to manage stress, a common trigger for hair loss, through therapy, exercise, and relaxation techniques may help with hair shedding while also contributing to your overall health and well-being.
  • If you notice significant hair loss, see your doctor. Testing for other autoimmune diseases may be recommended.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Sherbini AA et al. Rates and predictors of methotrexate-related adverse events in patients with early rheumatoid arthritis: results from a nationwide UK study. Rheumatology. October 2020.
  2. Arthritis Medications and Hair Loss. Arthritis Foundation.
  3. Lutf A et al. Weight Gain and Hair Loss during Anti-TNF Therapy. International Journal of Rheumatology. August 2012.
  4. Huang KP et al. Autoimmune, Atopic, and Mental Health Comorbid Conditions Associated With Alopecia Areata in the United States. JAMA Dermatology. July 2013.
  5. Zhong S et al. Association between genetically predicted rheumatoid arthritis and alopecia areata: a two-sample Mendelian randomization study. Frontiers in Immunology. October 2023.
  6. Nazary K et al. Prevalence of Thyroid Dysfunction in Newly Diagnosed Rheumatoid Arthritis Patients. Cureus. September 2021.
  7. Aboalola D et al. An Update on Alopecia and its Association With Thyroid Autoimmune Diseases. touchReviews in Endocrinology. August 8, 2023.
  8. Icen M et al. Systemic lupus erythematosus features in rheumatoid arthritis and their effect on overall mortality. Journal of Rheumatology. January 2009.
  9. Concha JSS et al. Alopecias in lupus erythematosus. Lupus Science & Medicine. October 2018.
  10. Lupus and Hair Loss. Lupus Foundation of America.
  11. Telogen Effluvium. Harvard Health Publishing. October 7, 2024.
  12. Methotrexate: Managing Side Effects. Arthritis Foundation.
  13. How Stress Affects Arthritis. Arthritis Foundation.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
Sian-Yik-Lim-bio

Sian Yik Lim, MD

Medical Reviewer
Castle Connolly Top Doctor
Sian Yik Lim, MD, is a board-certified rheumatologist at Hawaii Pacific Health. He is a clinical certified densitometrist, certified by the International Society of Clinical Densitometry. He completed his rheumatology fellowship at Massachusetts General Hospital and was also a research fellow at Harvard Medical School. His research interests include osteoporosis, gout, and septic arthritis. Dr. Lim has published in JAMA, Current Opinions in Rheumatology, Osteoporosis International, Bone, Rheumatology, and Seminars in Arthritis and Rheumatism.

Lim has authored several book chapters, including one titled “What is Osteoporosis” in the book Facing Osteoporosis: A Guide for Patients and their Families. He was also an editor for Pharmacological Interventions for Osteoporosis, a textbook involving collaboration from a team of bone experts from Malaysia, Australia, and the United States.
See full bio
Laurie Tarkan

Laurie Tarkan

Author

Laurie Tarkan has an extensive background in health journalism, and has written regularly for The New York Times. She is a frequent contributor to a host of magazines and health websites. Laurie is an accomplished editor and provides writing, editing, and website content for nonprofit organizations and for-profit healthcare companies.

Laurie is also the author of several health books, including My Mother's Breast: Daughters Face Their Mothers’ Cancer, and Perfect Hormone Balance for Fertility: The Ultimate Guide to Getting Pregnant.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network