Sometimes, this can lead to increased arm pain and stiffness
Dogan, S
You should rotate injection sites with each dose
Medical conditions associated with elevated B12: Liver disease: Hepatocellular damage (cirrhosis, hepatitis, hepatocellular carcinoma) releases stored B12 into circulation
Key pathophysiologic mechanisms include: Mucosal barrier dysfunction: Impaired epithelial tight junctions allow bacterial translocation, triggering innate immune activation T-helper cell dysregulation: Predominantly Th1 and Th17 pathways drive chronic inflammation via TNF-, IL-12, IL-23 the basis for biologic therapy targets Transmural inflammation: Unlike UC (mucosal only), CD involves all layers: mucosa submucosa muscularis propria serosa Granuloma formation: Non-caseating granulomas are pathognomonic but present in only ~3050% of biopsies Fibrosis and stricture: Chronic inflammation activates myofibroblasts collagen deposition luminal narrowing obstructive symptoms Fistula formation: Transmural ulcers penetrate serosa form sinus tracts connect to adjacent bowel, bladder, vagina, or skin 7
Depending on results and providers discretion the injections may be repeated up to 3-4 times per year for sustained pain relief
