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Informed consent statement Informed consent was obtained from all the subjects involved in this study, and written informed consent was obtained from the patients to publish this paper

They may arrange blood tests to evaluate: Inflammatory markers (ESR, CRP) to detect active inflammation Rheumatoid factor and anti-CCP antibodies if inflammatory arthritis is suspected Full blood count to assess haematological response to B12 treatment Thyroid function tests , as thyroid disorders commonly coexist with B12 deficiency Note that serum B12 levels are not typically measured to assess treatment adequacy once replacement therapy has begun, as they may not reliably reflect tissue stores

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