Does RA cause hair loss? For many people living with rheumatoid arthritis, hair thinning or shedding is a real and distressing concern. Although hair loss is not a primary feature of RA itself, it is a recognised associated problem — linked to chronic systemic inflammation, nutritional deficiencies such as iron deficiency, and several commonly prescribed disease-modifying medications including methotrexate and leflunomide. Understanding the underlying causes is essential, as many forms of RA-related hair loss are reversible once the trigger is identified and appropriately managed.

Can Rheumatoid Arthritis Cause Hair Loss?

RA can cause hair loss through systemic inflammation, medication side effects, and coexisting conditions; diffuse thinning is the most common pattern and is often reversible once the trigger is addressed.

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Rheumatoid arthritis (RA) is a chronic autoimmune condition in which the immune system mistakenly attacks the body's own tissues, primarily affecting the joints. However, RA is a systemic disease, meaning its effects can extend well beyond the joints — and for some people, this includes changes to hair growth and thickness.

Hair loss, medically known as alopecia, is not a primary diagnostic feature of RA itself, but it is a recognised associated concern for a proportion of people living with the condition. Some studies suggest that individuals with autoimmune diseases, including RA, may experience hair thinning or shedding more frequently than the general population, though robust prevalence data are limited. This can relate to the inflammatory processes involved in the disease, to medications used to manage it, or to coexisting conditions.

In many cases, the most common pattern is diffuse hair thinning — a general reduction in hair density across the scalp — rather than patchy or complete hair loss. Importantly, diffuse thinning associated with RA or its treatments is often reversible once the underlying trigger is identified and addressed.

However, if hair loss is patchy, accompanied by scalp redness, scaling, tenderness, or pustules, or involves the eyebrows or eyelashes, this may suggest a different or more serious cause — including scarring alopecia — and warrants prompt assessment by a dermatologist to prevent the risk of permanent hair loss. Raising any concerns about hair changes with your GP or rheumatology team is always appropriate.

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Why RA May Lead to Hair Thinning or Shedding

Chronic inflammation, iron deficiency anaemia, telogen effluvium triggered by disease flares, and overlap with conditions such as thyroid disease or alopecia areata all contribute to hair thinning in RA.

The relationship between RA and hair loss is multifactorial. Several biological and lifestyle factors associated with the condition can contribute to hair thinning or shedding:

• Systemic inflammation: Chronic inflammation — the hallmark of RA — can disrupt the normal hair growth cycle. Elevated levels of pro-inflammatory cytokines, such as tumour necrosis factor-alpha (TNF-α) and interleukins, may interfere with hair follicle function, pushing more hairs into the telogen (resting/shedding) phase prematurely.

• Iron deficiency and anaemia: Iron deficiency is the most evidence-based nutritional cause of diffuse hair thinning. In RA, this can result from anaemia of chronic disease, reduced dietary intake, or gastrointestinal blood loss associated with long-term NSAID use. A ferritin level is the most useful initial test. Other nutritional deficiencies (for example, vitamin D, zinc, or B vitamins) are sometimes implicated in hair loss, but routine testing for these is not recommended unless there is a specific clinical reason to suspect deficiency.

• Telogen effluvium: This is a form of temporary, diffuse hair shedding triggered by physical or emotional stress, illness, or significant nutritional deficiency. It typically begins two to three months after the triggering event — such as an RA flare, surgery, or a major change in health — and often resolves within three to six months once the trigger settles. The British Association of Dermatologists (BAD) provides patient information on telogen effluvium.

• Overlap with other autoimmune conditions: RA can coexist with other autoimmune disorders such as thyroid disease or alopecia areata, both of which independently cause hair loss. If hair loss is patchy, more pronounced, or accompanied by symptoms such as fatigue, weight change, or palpitations, it is worth investigating whether a secondary condition may be contributing.

Addressing disease activity and, where indicated, nutritional deficiencies are therefore key first steps in managing RA-related hair changes.

Medications Used in RA That Can Affect Hair Growth

Methotrexate, leflunomide, and sulfasalazine are the most commonly implicated DMARDs; folic acid supplementation alongside methotrexate helps reduce hair loss without compromising efficacy.

Several disease-modifying antirheumatic drugs (DMARDs) and other medications commonly prescribed for RA are known to affect hair growth. This is one of the most frequent causes of hair loss in people with RA and should always be considered when evaluating new or worsening hair thinning.

Methotrexate is one of the most widely used DMARDs for RA and is a well-recognised cause of diffuse hair thinning. It works by inhibiting folate metabolism and affects rapidly dividing cells, including hair follicle cells. Hair thinning typically begins within the first few months of treatment. Folic acid supplementation is routinely offered alongside methotrexate to help reduce side effects including hair loss, without compromising the drug's efficacy. Common practice, as described in the BNF and Specialist Pharmacy Service (SPS) guidance, is folic acid 5 mg once weekly, taken on a different day from methotrexate; however, the exact dose and regimen may vary according to local protocol. It is important to note that methotrexate is prescribed as a weekly dose — taking it daily is a serious prescribing error. Always follow your rheumatology team's instructions carefully.

Leflunomide, another conventional DMARD, is also associated with hair thinning in a proportion of patients according to its Summary of Product Characteristics (SmPC). The effect may be dose-dependent and can improve with dose reduction.

Sulfasalazine, another commonly used conventional DMARD, can also cause alopecia as a recognised adverse effect. This is generally reversible on dose reduction or discontinuation, and should be discussed with your rheumatology team if it occurs.

Biological therapies, including TNF inhibitors such as adalimumab and etanercept, have been associated with hair changes in some patients, though this is uncommon and the evidence is mixed. Individual SmPCs list alopecia as an infrequent adverse effect for some agents. Paradoxically, better control of systemic inflammation through biologic therapy may in some cases improve diffuse hair shedding.

Hydroxychloroquine, used in milder RA and related conditions, is occasionally associated with hair changes including alopecia and hair bleaching, as noted in its SmPC, though this is less commonly reported.

Patients should never stop their RA medication without first consulting their rheumatology team. The risks of uncontrolled disease activity generally outweigh the cosmetic impact of hair thinning, and alternative management strategies are usually available. Suspected adverse drug reactions, including hair loss, can be reported via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

When to Speak to Your GP or Rheumatology Team

Seek prompt advice for sudden or patchy hair loss, scalp changes suggesting scarring alopecia, hair loss after a medication change, or hair loss accompanied by new systemic symptoms such as fatigue or weight change.

Hair loss can be distressing, and it is always appropriate to raise concerns with your healthcare team. However, certain situations warrant more prompt attention:

• Sudden or rapid hair loss, particularly if it occurs in patches (which may suggest alopecia areata)

• Signs that may indicate scarring alopecia — including redness, scaling, tenderness, pain, or pustules on the scalp — which require prompt dermatology referral to reduce the risk of permanent hair loss

• Hair loss involving eyebrows, eyelashes, or body hair, which may suggest a different underlying cause

• Hair loss accompanied by other new symptoms, such as fatigue, weight changes, palpitations, or skin rashes, which may suggest an underlying thyroid disorder or lupus

• Hair loss that begins shortly after starting or changing a medication, which should be reported to your rheumatologist or GP as soon as possible

• Significant psychological distress related to hair changes, which may warrant referral to a counsellor or dermatologist

Your GP may arrange targeted blood tests to investigate potential contributing factors, guided by your history and examination. Tests that are commonly considered include:

• Full blood count (to check for anaemia)

• Ferritin and iron studies (the most evidence-based nutritional investigation for hair loss)

• Thyroid function tests

• Inflammatory markers (CRP, ESR)

Additional tests — such as vitamin D, zinc, or B12 levels — may be arranged if there is a specific clinical reason to suspect deficiency, but are not routinely indicated for hair loss alone.

If a medication is suspected as the cause, your rheumatology team may consider adjusting the dose, switching to an alternative DMARD, or optimising folic acid supplementation. A referral to NHS Dermatology may be appropriate if the cause remains unclear, if the hair loss is severe, or if scarring alopecia is suspected. Suspected adverse drug reactions, including hair loss, should be reported via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Managing Hair Loss Alongside Your RA Treatment

Optimising RA disease control is the most important step; nutritional deficiencies should be corrected under medical guidance, and topical minoxidil for diffuse shedding is off-label and requires GP or dermatologist discussion.

Managing hair loss in the context of RA requires a balanced approach that prioritises disease control whilst addressing the factors contributing to hair thinning. There is no single solution, but a combination of strategies can make a meaningful difference.

Optimising disease control is the most important step. When RA is well managed and inflammation is reduced, many patients notice an improvement in hair quality and density over time. Working closely with your rheumatology team to achieve remission or low disease activity is therefore central to addressing hair loss.

Nutritional support plays a key role where a deficiency has been identified. If blood tests confirm iron deficiency, for example, supplementation under medical guidance can support hair regrowth. A balanced diet rich in protein, leafy vegetables, and healthy fats also supports general follicle health. It is important to avoid high-dose over-the-counter supplements without medical advice, as some can be harmful in excess.

Practical hair care measures that may help reduce the visual impact of thinning include:

• Using gentle shampoos and avoiding excessive heat styling or tight hairstyles that place tension on the scalp

• Considering a shorter hairstyle to reduce the appearance of thinning

• Using volumising hair products designed for fine or thinning hair

These measures are supportive rather than therapeutic, and the evidence base for specific hair care products is limited.

Topical minoxidil is a licensed treatment for androgenetic alopecia (pattern hair loss) in the UK and is available over the counter. Its use for diffuse hair shedding or telogen effluvium — which is more typical in RA — is off-label and should be discussed with a GP or dermatologist before starting. Common side effects include initial increased shedding (which usually settles), scalp irritation, and itching. If benefit occurs, it may take three to six months to become apparent. If you are taking antihypertensive medicines, discuss this with your GP or pharmacist before using topical minoxidil, as additive blood pressure-lowering effects are theoretically possible, though clinically significant interactions with topical use are uncommon.

NHS Support and Further Resources for RA Symptoms

NHS rheumatology and dermatology services, NICE guideline NG100, and charities including Versus Arthritis, NRAS, and Alopecia UK all provide relevant support and information for people experiencing RA-related hair loss.

Living with RA and its associated symptoms, including hair loss, can have a significant impact on quality of life and emotional wellbeing. A range of NHS and charitable resources are available to provide support.

NHS services that may be relevant include:

• Your GP surgery, as the first point of contact for new or changing symptoms

• NHS Rheumatology departments, which manage RA treatment and can coordinate care with other specialties

• NHS Dermatology services, for assessment and management of significant, unexplained, or potentially scarring hair loss

• NHS Talking Therapies, which offers psychological support for people experiencing anxiety or low mood related to chronic illness

NICE Guideline NG100 (Rheumatoid arthritis in adults) sets out the framework for RA diagnosis and management in England and Wales, including monitoring for DMARD adverse effects such as hair changes.

The following organisations also offer valuable information and peer support:

• Versus Arthritis (versusarthritis.org) — the UK's leading arthritis charity, offering helplines, online communities, and detailed condition and medication guides including information on methotrexate and leflunomide side effects

• NRAS (National Rheumatoid Arthritis Society) (nras.org.uk) — a specialist charity providing RA-specific support, including information on medication side effects

• Alopecia UK (alopecia.org.uk) — for those experiencing more significant hair loss, this charity offers emotional support and practical advice

• British Association of Dermatologists (BAD) (bad.org.uk) — provides patient information on conditions including telogen effluvium and alopecia areata

• Primary Care Dermatology Society (PCDS) (pcds.org.uk) — offers guidance on hair loss assessment and referral pathways

Suspected adverse drug reactions, including hair loss associated with RA medicines, can be reported via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

If you are concerned about hair loss in the context of your RA, do not hesitate to raise it at your next appointment. It is a legitimate and recognised concern, and your healthcare team can help identify the cause and explore appropriate management options.

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