Living with rheumatoid arthritis (RA) is already a demanding journey – the constant pain, stiffness, and fatigue can take a physical and emotional toll. But for many, an unexpected and distressing side effect adds to the challenge: hair thinning or even significant hair loss. Watching strands fall out in the shower or noticing a thinner ponytail can be alarming, especially when you’re already managing a chronic illness.
This leads to one of the most common questions among people with RA:
“Can rheumatoid arthritis cause hair loss?”
The short answer is yes – but the reasons are often multi factorial. Hair loss in those with rheumatoid arthritis can arise from several sources: the autoimmune process itself, certain RA medications such as methotrexate, nutrient deficiencies, stress, or even hormonal and thyroid changes linked to chronic inflammation.
In this article, we’ll explore how rheumatoid arthritis and its treatments can affect hair health, why some people experience thinning while others don’t, and most importantly – what you can do to protect, restore, and manage your hair while treating RA
How Rheumatoid Arthritis Itself Can Affect Your Hair
Is Hair Loss a Symptom of Rheumatoid Arthritis?
While hair loss isn’t considered one of the primary symptoms of rheumatoid arthritis, many people living with RA notice that their hair becomes thinner, weaker, or sheds more than usual. This can happen even in those not taking medications like methotrexate.
The reason lies in how RA affects the body’s immune system and overall health.
1. The Role of the Autoimmune Response
Rheumatoid arthritis is an autoimmune disease, which means the immune system mistakenly attacks the body’s own tissues most notably the joints. But this inflammatory response isn’t limited to the joints alone. Systemic inflammation can also interfere with the normal hair growth cycle, pushing more hair follicles into the “resting” or telogen phase.
When inflammation levels remain high for long periods, the scalp’s environment becomes less supportive of new growth, leading to gradual thinning or shedding. Essentially, the same immune processes that cause joint pain and swelling can also disrupt the balance of your hair’s life cycle.
2. Impact on Hair Follicles
In some cases, the immune system’s overactivity can directly affect hair follicles, causing them to weaken or shut down temporarily. Chronic inflammation can restrict blood flow and nutrient delivery to the scalp, depriving follicles of the oxygen and nutrients they need to grow strong, healthy strands. Over time, this can result in noticeable hair breakage and thinning, especially around the crown and hairline.
3. Telogen Effluvium
Another common type of hair shedding in people with rheumatoid arthritis is known as telogen effluvium a condition where physical or emotional stress triggers a large number of hairs to enter the shedding phase at once.
RA flares, pain, fatigue, and the psychological strain of managing a lifelong illness can all act as triggers. The good news is that telogen effluvium is usually temporary; once inflammation and stress are better controlled, normal hair growth often resumes within a few months.
Co-occurring Conditions
1. Alopecia Areata
People with rheumatoid arthritis are also at higher risk for other autoimmune conditions, such as alopecia areata a disorder in which the immune system directly attacks hair follicles, leading to patchy hair loss on the scalp and sometimes other areas of the body. While alopecia areata is separate from RA, both share a common autoimmune foundation, meaning it’s not unusual for someone with RA to experience both.
2. Nutrient Deficiencies
Chronic inflammation and certain RA medications can interfere with the absorption of key nutrients essential for healthy hair growth including iron, zinc, folate, and vitamin D. Low levels of these nutrients can weaken hair structure and slow regrowth, compounding the effects of inflammation or medication-related hair loss.
Ensuring a balanced diet and discussing supplement options with your doctor can help restore nutrient balance and support healthier hair over time.
RA Medications and Hair Loss
Methotrexate-Induced Hair Loss
Among all rheumatoid arthritis (RA) medications, methotrexate is the most commonly associated with hair loss. While it’s one of the most effective drugs for controlling inflammation and slowing joint damage, it can also have side effects that affect hair health.
1. Why It Happens
Methotrexate works by targeting rapidly dividing cells in the body the same type of cells involved in both immune activity and hair growth. Because hair follicles contain some of the fastest-dividing cells, they can become collateral damage in this process.
By inhibiting the enzyme dihydrofolate reductase, methotrexate disrupts the use of folate, a B-vitamin essential for DNA synthesis and cell replication. This can cause hair follicles to weaken or shed prematurely, leading to noticeable thinning in some individuals.
2. What to Expect
Hair loss from methotrexate is usually mild to moderate, not complete. Most people experience diffuse thinning rather than distinct bald patches, and it often becomes noticeable a few months after starting treatment.
The degree of hair loss varies from person to person some may only see extra strands in the shower or on their brush, while others may notice a visible reduction in hair volume. The good news: hair loss from methotrexate is typically reversible once the body adjusts to the medication or if dosage adjustments are made under medical supervision.
3. The Role of Folic Acid
To help reduce methotrexate-related side effects including hair loss, fatigue, and mouth sores doctors often prescribe folic acid or folinic acid supplements.
Folic acid replenishes what methotrexate depletes, supporting healthy cell turnover and protecting hair follicles. Taking folic acid daily or as directed by your rheumatologist can significantly minimize hair shedding and improve overall tolerance to the medication.
If someone asks, “Are you taking folic acid?” it’s a crucial part of methotrexate therapy that can make a noticeable difference in both health and hair.
Other Medications That Can Cause Hair Thinning
While methotrexate is the most discussed, other RA medications can also contribute to hair loss or thinning, though this tends to be less common.
1. DMARDs (e.g Leflunomide)
Leflunomide, another disease-modifying antirheumatic drug (DMARD), can occasionally cause diffuse hair thinning similar to methotrexate. Like methotrexate, it interferes with cell division, which can impact the hair growth cycle. Fortunately, this side effect often improves when the dosage is lowered or the drug is switched.
2. Biologics (e.g., Remicade, Humira)
Biologic therapies, such as Remicade (infliximab) or Humira (adalimumab), work differently by targeting specific immune system proteins. Hair loss is rare with these drugs, but some patients have reported thinning or increased shedding. This may be related more to immune system changes or disease stress than the drug itself.
Never Stop a Medication Without Consulting Your Rheumatologist
Experiencing hair loss can be frustrating and emotionally difficult, but it’s vital not to stop your medication on your own. The benefits of RA medications controlling inflammation, preventing joint damage, and maintaining mobility usually outweigh the cosmetic side effects.
Always discuss any hair changes with your rheumatologist. They can help you explore solutions such as adjusting the dose, switching to a different drug, or adding supplements like folic acid or biotin. Together, you can find the right balance between managing RA effectively and supporting healthy hair growth.
Treatment and Management: How to Fight Back
Medical Interventions
Dealing with hair loss caused by rheumatoid arthritis (RA) can be discouraging, but the good news is that it’s often manageable and reversible. The key is identifying what’s driving the shedding whether it’s inflammation, medication, or stress and addressing it with professional guidance.
1. Consulting Your Rheumatologist
Your rheumatologist should always be the first point of contact when you notice unusual hair loss. They can help determine whether the issue stems from RA medications (like methotrexate or leflunomide) or from disease activity itself.
If medication is the cause, your doctor may:
- Adjust the dosage to minimize side effects.
- Switch to an alternative DMARD or biologic with a lower risk of hair thinning.
- Add folic acid supplementation, if not already part of your treatment plan.
Never make changes on your own stopping medication abruptly can cause RA flares and worsen overall health.
2. Seeing a Dermatologist
A dermatologist can provide an in-depth assessment of your scalp and hair to identify the exact type of hair loss you’re experiencing whether it’s telogen effluvium, alopecia areata, or another condition.
They may use scalp examinations, trichoscopy, or lab tests to look for underlying nutrient deficiencies, thyroid issues, or hormonal imbalances that could worsen hair shedding. With this information, they can recommend targeted treatments and guide you on what to expect in terms of regrowth.
3. Topical Treatments (e.g., Minoxidil)
In some cases, dermatologists recommend topical treatments such as minoxidil (Rogaine) to stimulate new hair growth. Minoxidil can help prolong the growth phase of hair follicles and reduce shedding.
It’s available in foam or liquid form and can be used by both men and women. While it doesn’t address the root cause (RA or medication), it can support regrowth once inflammation or drug side effects are under control.
Promoting Healthy Hair Growth
Beyond medical intervention, small daily habits and nutrition play a powerful role in restoring stronger, fuller hair.
1. Nutritional Support
A balanced, anti-inflammatory diet can nourish both your joints and your hair. Focus on foods rich in the following nutrients:
- Iron and Zinc: Found in lean meats, spinach, lentils, and pumpkin seeds essential for follicle health.
- Biotin and Folate: Support healthy keratin production (found in eggs, leafy greens, and beans).
- Omega-3 Fatty Acids: Help reduce inflammation and nourish the scalp (from salmon, chia seeds, flaxseed oil).
- Vitamin D: Low levels are common in RA and linked to hair thinning consider safe sun exposure or supplements under medical advice.
Hydration also matters staying well-hydrated supports overall scalp circulation.
2. Gentle Scalp and Hair Care
Your hair and scalp need extra care during periods of shedding. Try these practical tips:
- Use sulfate-free shampoos and moisturizing conditioners to minimize dryness and breakage.
- Avoid tight hairstyles, heat styling, and harsh chemical dyes that can weaken hair.
- Consider a wide-tooth comb or soft brush designed for sensitive joints (helpful if arthritis affects your hands).
- Gentle scalp massages can improve blood flow, promoting healthier growth.
Consistency and patience are key results often take a few months to show.
Does Hair Grow Back After Falling Out from RA?
For most people, the answer is yes.
In cases where hair loss is caused by medication, inflammation, or stress, regrowth usually begins once the underlying trigger is managed. When RA is under control, and with proper nutritional and topical support, hair follicles typically recover their normal growth cycle.
However, if hair loss stems from scarring alopecia or long-term follicle damage (which is rare in RA), regrowth may be more limited. That’s why early intervention and professional evaluation are so important.
The encouraging takeaway: RA-related hair loss doesn’t have to be permanent. With the right medical care, supplements, and self-care habits, most patients see significant improvement over time.
Practical Lifestyle and Hair Care Tips for People with RA
Living with rheumatoid arthritis often means adapting daily routines including hair care to reduce strain on your joints while keeping your hair healthy and confident-looking. With a few smart adjustments and gentle practices, you can make hair care easier, safer, and even more enjoyable.
Daily Hair Care with Joint Pain
Simple tasks like brushing, washing, or styling hair can feel challenging when joint pain, stiffness, or fatigue set in. These strategies can help minimize discomfort and make self-care more manageable.
1. Choosing the Right Tools
If you experience hand or wrist pain, opt for lightweight brushes and combs with ergonomic or cushioned handles designed for easy grip and control. These are often labeled as “hair brushes for rheumatoid arthritis” or adaptive grooming tools.
Detangling brushes with flexible bristles reduce tugging, while wide-tooth combs can glide through hair gently without pulling. Consider electric or battery-powered tools (like automatic curlers or dryers with easy-grip handles) to reduce repetitive hand motions.
2. How to Wash Hair with RA
Washing your hair doesn’t have to be exhausting a few adjustments can make the process smoother:
- Use pump dispensers for shampoo and conditioner instead of flip caps, reducing hand strain.
- Install a handheld showerhead so you can control water direction easily.
- A shower chair or stool allows you to sit while washing your hair, conserving energy and protecting your joints.
- If lifting your arms overhead is painful, consider washing hair over a sink using a flexible faucet attachment.
These small modifications can help make hygiene less physically taxing on flare-up days.
3. Managing Hair Texture Changes
Rheumatoid arthritis, medications, and hormonal shifts can change how your hair feels becoming dry, brittle, or oily over time.
- For dry hair, use moisturizing shampoos with ingredients like argan oil, shea butter, or keratin. Avoid frequent heat styling and use leave-in conditioners for added hydration.
- For oily hair, try lightweight, clarifying shampoos and avoid over-washing (which can trigger more oil production).
- If texture changes are sudden or severe, consult your dermatologist it could be related to medication or nutritional deficiencies.
Styling and Coloring Hair
Your hairstyle and color routine can both protect your hair and boost your confidence, especially when dealing with thinning or shedding.
1. Hair Dye and Rheumatoid Arthritis: Is It Safe?
Many people with RA wonder if coloring their hair is safe especially when dealing with sensitive skin or scalp inflammation.
Generally, hair dye is safe when used properly, but there are a few precautions:
- Always perform a patch test 48 hours before applying dye to check for allergic reactions.
- Choose ammonia-free or low-chemical dyes that are gentler on the scalp.
- Avoid coloring during RA flare-ups when your skin may be more sensitive.
- For those with severe scalp irritation or open lesions, wait until the area heals before dyeing.
If in doubt, talk to your dermatologist before any chemical treatment.
2. Hairstyles for Thinning Hair
If you’re experiencing thinning, the right cut or style can make a world of difference.
- Opt for layered cuts to create natural volume and movement.
- Consider shorter styles, which tend to look fuller and require less maintenance.
- Use volumizing mousses or lightweight sprays instead of heavy gels that weigh hair down.
- Avoid tight ponytails or braids that pull on fragile strands.
For mature women with RA-related thinning, soft bobs, pixie cuts, or shoulder-length layers are flattering and low-stress options that enhance fullness without overworking the hair.
Hair Stylists with Rheumatoid Arthritis
Rheumatoid arthritis doesn’t have to end a hairstyling career but it does require smart ergonomics and self-care.
Tips for hair stylists managing RA:
- Use adjustable chairs and stools to maintain a comfortable working posture.
- Choose lightweight dryers and shears to reduce wrist and hand fatigue.
- Schedule frequent short breaks to stretch your hands and shoulders.
- Wear compression gloves or braces during flare-ups for extra joint support.
- Don’t hesitate to delegate shampooing or prolonged tasks on difficult days.
With the right tools, pacing, and awareness, stylists with RA can continue their work without worsening symptoms keeping both their clients and their joints happy.
Special Considerations
Juvenile Rheumatoid Arthritis (JRA) and Hair Loss
Hair loss doesn’t only affect adults with rheumatoid arthritis it can also occur in children and adolescents diagnosed with Juvenile Rheumatoid Arthritis (JRA), also known as Juvenile Idiopathic Arthritis (JIA).
The underlying causes are often similar to those seen in adults:
- Medication-related effects, especially from methotrexate or other DMARDs.
- Systemic inflammation, which disrupts nutrient absorption and hair growth cycles.
- Physical and emotional stress from managing a chronic illness at a young age.
For children experiencing hair thinning or shedding, it’s essential to work closely with a pediatric rheumatology team. They can monitor medication side effects, ensure proper nutrition, and, if necessary, collaborate with a pediatric dermatologist to assess scalp and follicle health.
Parents and caregivers can also help by focusing on gentle hair care routines, ensuring adequate folic acid supplementation, and providing emotional reassurance. In most cases, hair regrowth occurs once the disease and its treatments are balanced.
Finding Community and Support
Hair loss can take a deep emotional toll, especially when it adds to the challenges of living with a chronic condition like RA. Feelings of frustration, lowered confidence, or self-consciousness are completely valid but you’re not alone in this experience.
Connecting with others who understand what you’re going through can make a huge difference. Support groups, online forums, and arthritis foundations offer spaces to share stories, coping strategies, and encouragement.
Helpful communities include:
- The Arthritis Foundation (arthritis.org)
- CreakyJoints – An online community offering education and support for people with RA.
- Reddit forums such as r/Rheumatoid or r/Hairloss, where patients discuss real experiences and recovery stories.
Sharing your journey and learning from others can provide both practical tips and emotional comfort, reminding you that managing RA and hair loss is possible and that regrowth, confidence, and well-being often follow with the right care and support.
Hope, Healing, and Hair Regrowth in RA
Hair loss is an often-overlooked yet emotionally impactful part of living with rheumatoid arthritis (RA). While it can be distressing, understanding the causes helps make it more manageable:
- RA itself through chronic inflammation, stress, and autoimmune activity can contribute to hair thinning or shedding.
- Medications, particularly methotrexate, are among the most common and direct causes, as they affect rapidly dividing cells like those in hair follicles.
- Good management is possible. With the right balance of medical care, nutritional support, and gentle hair practices, many people see their hair stabilize and even regrow over time.
Final Empowering Message
If you’re experiencing hair loss with rheumatoid arthritis, remember you’re not powerless. Talk openly with your rheumatologist and dermatologist about your symptoms. Small adjustments, such as tweaking medication doses, adding folic acid or leucovorin, or using topical treatments, can make a real difference.
RA management is about more than just easing joint pain it’s about improving your overall well-being, confidence, and quality of life. With patience, self-care, and a proactive healthcare team, you can manage RA and regain both your strength and your hair health.
