Is hair loss common in patients with gout and polymyalgia rheumatica (Polymyalgia Rheumatica)?

Hair Loss in Gout and Polymyalgia Rheumatica

Hair loss is not a common symptom directly associated with gout or polymyalgia rheumatica (PMR), but may occur as a side effect of medications used to treat these conditions, particularly glucocorticoids.

Medication-Related Hair Loss in PMR and Gout

Glucocorticoid-Induced Hair Loss

• Glucocorticoids (such as prednisone), which are the primary treatment for PMR, can cause hair loss through multiple mechanisms 1:
  • May induce telogen effluvium (hair loss occurring 2-4 months after starting treatment)
  • Can occasionally cause hirsutism or hypertrichosis (excessive hair growth)
  • Standard PMR treatment involves prednisone 12.5-25 mg daily with gradual tapering over 1-2 years 2

Other Medications and Hair Loss

• Colchicine (used for gout) may occasionally cause hair loss
• Allopurinol (used for gout) has rarely been associated with hair loss
• Methotrexate (sometimes used as a steroid-sparing agent in PMR) can cause hair loss in some patients 2

Clinical Considerations

Distinguishing Medication-Induced Hair Loss

• Telogen effluvium typically presents 2-4 months after starting treatment 1, 3
• Hair loss is usually diffuse rather than patchy
• Generally reversible after discontinuation of the medication
• Severity varies based on individual predisposition and medication dosage 1

Confounding Factors

• Other causes of hair loss must be excluded before attributing it to medication 4:
  • Fever
  • Severe illness
  • Stress
  • Hormonal changes
  • Nutritional deficiencies

Rare Association with Disease Process

• While not a common symptom, hair loss has been occasionally reported in the literature as a nonspecific symptom in patients with giant cell arteritis (GCA), which can be associated with PMR 5
• This is not a primary or common manifestation of either PMR or gout

Management Approach

1. Assess medication regimen:

   • Review timing of hair loss in relation to medication initiation
   • Consider dose-related effects (higher doses of glucocorticoids may increase risk)

2. Consider medication adjustments (in consultation with rheumatologist):

   • For PMR patients with significant hair loss, consider early introduction of methotrexate as a steroid-sparing agent to reduce glucocorticoid dose 6, 2
   • Methotrexate dosage typically 7.5-10 mg/week orally 2

3. Supportive care:

   • Reassure patients that drug-induced hair loss is usually reversible after treatment completion or dose adjustment 1
   • Avoid harsh hair treatments that may worsen hair breakage 3

4. Monitor for other steroid-related side effects:

   • Regular assessment of glucocorticoid-related side effects is recommended every 4-8 weeks in the first year of treatment 2

Important Caveats

• Hair loss is not listed as a primary symptom of PMR or gout in major guidelines 6, 2
• When hair loss occurs, it is more likely related to treatment rather than the disease itself
• The 2015 EULAR/ACR recommendations for PMR management do not specifically address hair loss as a treatment consideration or side effect 6
• Patients should not discontinue prescribed medications without consulting their healthcare provider

If hair loss is severe or distressing, consider referral to dermatology for additional evaluation and management options while continuing necessary treatment for the underlying rheumatologic condition.