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Key Takeaways Key Takeaways Cortisone shots are anti-inflammatory steroid injections used to alleviate joint pain

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Where clinical suspicion remains high despite a normal serum B12, additional markers may be requested, including: Holotranscobalamin (active B12) a more specific marker of B12 status, available in some UK laboratories as an alternative or confirmatory test [11] [12] Methylmalonic acid (MMA) elevated in functional B12 deficiency

Although most studies have focused on bacterial changes such as increased Streptococcus and Veillonella and decreased Faecalibacterium 63,64,65,66 , fungal involvement is supported by clinical observations of severe fungal infections in PSC patients 67,68 and serological evidence such as elevated ASCA in PSC populations 69