Thank you for your question.
Methotrexate is a first-line treatment for rheumatoid arthritis as per and is crucial for managing the disease. However, rheumatoid arthritis itself, being an autoimmune condition, can cause hair loss, so it’s essential to confirm first that methotrexate is the cause of hair loss. Methotrexate can contribute to hair loss by interfering with folic acid metabolism, which is why patients are prescribed folic acid supplements. Are you currently on folic acid ? Is it the correct dose based on age and weight ?
If you suspect methotrexate is responsible, ensure you are taking the correct dose of folic acid and discuss with your doctor whether an increased dose might help. Additionally, checking for deficiencies like iron, zinc, or vitamin D through simple blood tests can rule out other causes. If the hair loss persists or causes significant distress, another option could be switching from oral methotrexate to the injectable form, which may have fewer side effects. This adjustment should only be made in consultation with your rheumatologist, who can tailor the injectable regimen to your needs.
It’s quite fascinating that methotrexate can, in some cases, actually promote hair growth, such as in conditions like alopecia areata by reducing inflammation caused by autoimmune causes. However, in rare instances, it can lead to hair loss, as it may be in your case. The good news is that by following the plan above you should be able to address the issue effectively and see improvements.
Just to summarise:
1) Check with your rheumatologist if you are on correct folic acid dose
2) Get FBC, ferritin, iron, zinc, B12, folic acid levels
3) Review methotrexate regimen (your rheumatologist might be able to switch it to injectable form)
4) If the problem still persists next step would be dermatology review