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NHS approach to B12 deficiency: NICE Clinical Knowledge Summaries recommend investigating B12 deficiency in patients presenting with macrocytic anaemia, unexplained neurological symptoms, or risk factors including pernicious anaemia, gastrectomy, malabsorption disorders, metformin use, proton pump inhibitors, or nitrous oxide exposure

The problem arises when knee inflammation becomes prolonged or excessive, as can happen during osteoarthritis flares, after major reconstructions, and in chronic tendon conditions around the knee