Can Hair Loss Be a Symptom of Ankylosing Spondylitis?

Ankylosing spondylitis (AS) and hair loss can occur at the same time for many reasons, including as a side effect of certain drugs used to treat the pain and swelling that occur with this chronic inflammatory disease. In some cases, hair loss may be a symptom of a different health problem that also exists.

Treating hair loss may or may not involve changing the drugs you use to manage pain and swelling. Finding the cause of hair loss is key to solving this problem. The proper treatment can help improve your feelings and self-image. This can result in a better quality of life.

This article describes the link between the two ailments, treatment options, and when to contact your healthcare provider to address this problem.

What Is Hair Loss?

Hair loss, known in clinical terms as alopecia, is a condition in which new hair doesn't replace the hair that falls out. It can occur as a result of several different conditions. The problem can involve any area of your body, though it affects the scalp most often.

Hair loss is usually treated by a dermatologist, though consultations with other medical specialists may be necessary to diagnose and treat the condition's underlying cause. Depending on the cause of hair loss, it can be temporary or permanent.

Hair loss can occur as a result of several different factors. Here are some common causes of hair loss:

• Genetic predisposition to male-pattern hair loss in men and women
• Drastic changes to your body, such as childbirth, surgery, or a hormonal imbalance
• Mineral or vitamin deficiency
• Certain medications
• Exposure to certain chemicals or medical treatments, like chemotherapy
• Development of an autoimmune disorder called alopecia areata, bacteria, or fungi
• Infection with tinea capitis, also known as scalp ringworm
• Abnormalities in the hair shaft that make hair strands more vulnerable to breaking, thinning, or falling out

While hair loss usually isn't a medical problem, it can impact your quality of life. It is common to experience feelings of embarrassment, low self-esteem, or other types of emotional suffering with hair loss. If you're having trouble coping with hair loss, talk to your healthcare provider about ways to cope and options for mental health support.

Is Hair Loss a Symptom of Ankylosing Spondylitis?

While hair loss can occur with ankylosing spondylitis, results of a 2022 study indicate that hair loss is not due to AS. Researchers concluded that patients with ankylosing spondylitis do not have a higher risk of hair loss than people who do not have AS.

If you have ankylosing spondylitis and hair loss, you may have drug-induced hair loss caused by certain medications commonly used to treat AS. It may be linked to one of the following types of drugs:

Methotrexate

Methotrexate is a disease-modifying antirheumatic drug (DMARD) used to treat AS. It is sold as a generic medication and also under the following brand names:

• Rheumatrex
• Trexall
• Otrexup
• Rasuvo

Methotrexate functions by changing the way your immune system works. This action interferes with cell growth, reducing symptoms and slowing disease progression. However, methotrexate can also interfere with the cells that support hair follicles. Up to 3% of people who take methotrexate experience hair loss.

Tumor Necrosis Factor (TNF) Inhibitors

Tumor necrosis factor (TNF) inhibitors, also called TNF-alpha inhibitors or TNFa inhibitors, are a class of medications used to reduce inflammation in ankylosing spondylitis. They work by blocking TNFa, a protein that can contribute to chronic inflammation and joint damage. Research indicates that hair loss can occur as a side effect of these drugs, though its prevalence is hard to determine based on limited controlled trials.

The following TNF inhibitors are used to treat ankylosing spondylitis:

• Enbrel (etanercept)
• Remicade (infliximab)
• Humira (adalimumab)
• Simponi (golimumab)
• Cimzia (certolizumab pegol)

Treatments and Management of Hair Loss

Depending on the cause of your hair loss, you may be able to slow or reverse this problem with one or more proven treatments. If you have hair loss as a result of an underlying health condition, infection, or external factor, you will have to address that problem before normal hair growth can resume.

Consulting with a dermatologist can help you determine the cause of your hair loss. Certain diagnostic tests such as a complete blood count (CBC) test or a scalp biopsy may be necessary to diagnose your condition.

Depending on the cause and extent of your problem, the following strategies may be advised:

• Different medication: If your hair loss is linked to medication, your healthcare provider may be able to change your prescriptions or adjust the dose of an existing drug to reduce the degree of hair loss you experience. Do not attempt to discontinue or change the dosage of a prescribed medication without medical advice. Doing so could jeopardize the treatment of your AS or other health conditions.
• Prescription medication for hair regrowth: If you are taking medication for AS, check with your healthcare provider to ensure that any hair loss treatments don't interfere with the action of medications prescribed to manage your disease. Prescription medications used to treat hair loss include Propecia (finasteride) and Aldactone (spironolactone).
• At-home treatments: Using at-home treatments can offer the most convenient and economical ways to treat hair loss. Common at-home treatments include Rogaine (minoxidil) topical treatment, at-home laser cap or comb, micro-needling, vitamins, minerals, and/or other supplements when deficiency is diagnosed.
• Dermatologist-administered treatments: Dermatologist-administered treatments are usually performed on an outpatient basis in a dermatologist's office. They may require downtime to recuperate after the procedure. Procedures can include corticosteroid injections, hair transplants, laser therapy, and platelet-rich plasma (PRP) therapy.

When to See Your Healthcare Provider

Hair loss can be a sign of a health condition or other changes in your body. Ignoring hair loss can allow untreated problems to develop and potentially interfere with your existing treatment for ankylosing spondylitis or other health issues.

Contact your healthcare provider if you develop any of the following symptoms related to hair loss:

• Unusual pattern of hair loss
• Hair loss that occurs at an early age
• Male-pattern baldness in women
• An abnormal menstrual cycle
• Areas of pain, itching, or infection on your scalp
• Areas of hair loss that appear red, scaly, or abnormal
• Weight gain, muscle weakness, fatigue, or chills that occur with hair loss
• Areas of hair loss on your eyebrows or beard

Summary

While people with ankylosing spondylitis may have hair loss, it is not a symptom of AS. Hair loss may occur as a side effect of certain drugs that help manage the pain and swelling common in this disease. You may also lose your hair for other reasons, like infection or other health problems.

You may be able to reverse or reduce hair loss by changing drugs or using hair loss treatments. You'll get the best results from hair loss treatments when you know the cause of the problem. The right treatment can help improve your quality of life and boost your self-image. This can help you better handle the challenges of chronic pain that the disease presents.

A Word From Verywell

Hair loss can occur for a variety of reasons among men and women in the general population. Research indicates that ankylosing spondylitis does not increase your risk of this side effect, so it's important to discover the cause of your hair loss. This information can help you determine the best way to restore hair growth.

Your hair is an important part of your self-image and physical appearance. It's common to have feelings of embarrassment or sadness with hair loss, regardless of the cause. Living with ankylosing spondylitis can be a challenge, and dealing with hair loss at the same time can worsen your emotional well-being and interfere with your quality of life.

Seek advice from your healthcare provider on ways to address hair loss. If your hair loss is interfering with your ability to function socially and professionally, you may benefit from consulting with a mental health professional to help you cope.