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Inflammation in the GI tract often leads to lower stomach acid which impairs the absorption of B12

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Redness over an involved joint (gout is highly inflammatory) Involvement of the base of the big toe on one side (the most common site for gout) Involvement of the joints at the middle of the foot Uric acid elevation on blood testing X-ray findings of swelling of joints which is not symmetrical Joint fluid is tested for infection and is negative