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A new perspective on vitamin B12 deficiency in rheumatology: a case-based review

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Abstract

Vitamin B12 (cobalamin) deficiency is common in patients with rheumatic diseases. Pernicious anemia is a well-known cause, but recent reports suggest that autoimmune-derived deficiency may not be limited to this cause alone. Symptoms of low vitamin B12 concentration are often deceptive, mimicking and overlapping with symptoms of other conditions. Neuropsychiatric manifestations, anemia, and fatigue are frequently attributed to a rheumatic disease without further evaluation. In this study, we present three cases of patients with neuropathic pain, depression, fatigue, and muscle weakness, initially attributed to a rheumatic disease, which almost completely resolved after implementing vitamin B12 supplementation. Furthermore, we provide an overview of current scientific reports regarding the potential use of cobalamin in rheumatology. Treatment of pain and neuropathy, often very challenging in long-lasting rheumatic diseases, can be more effective after a course of vitamin B12, even when no apparent deficiency is detected in laboratory tests. Considering recent research demonstrating vitamin B12’s nerve-protecting properties, we recommend that physicians should assess vitamin B12 levels early in the diagnostic process of rheumatic diseases. In specific cases, physicians should consider cobalamin supplementation regardless of vitamin B12 serum concentration.

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Author notes

  1. Natalia Aleksandra Dułak and Magdalena Rytlewska contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdansk, Gdansk, Poland

    Natalia Aleksandra Dułak, Magdalena Rytlewska, Marta Jaskólska & Michał Chmielewski

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  1. Natalia Aleksandra Dułak
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  2. Magdalena Rytlewska
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  3. Marta Jaskólska
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  4. Michał Chmielewski
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Contributions

The clinical management of patients from cases 1 and 2: MR. The clinical management of the patient from case 3: NAD. Literature review, preparation and writing the original article: NAD, MR, MJ. Reviewing and editing the manuscript: MJ and MC. Supervision: MJ and MC.

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Correspondence to Natalia Aleksandra Dułak.

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Dułak, N.A., Rytlewska, M., Jaskólska, M. et al. A new perspective on vitamin B12 deficiency in rheumatology: a case-based review. Rheumatol Int 44, 737–741 (2024). https://doi.org/10.1007/s00296-024-05539-y

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