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Hi I have been having 3 monthly injections on NHS for nearly 20 years

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NICE Clinical Knowledge Summaries advise oral cyanocobalamin for dietary deficiency, while intramuscular hydroxocobalamin is recommended for pernicious anaemia or malabsorption syndromes

Intra-articular/soft-tissue injection: The dose depends on the size of the joint or lesion. A general guideline (from FDA labeling) is: Large joints (knee, ankle, shoulder) 2080 mg (0.52 mL); Medium joints (elbow, wrist) 1040 mg (0.251 mL); Small joints (fingers, toes) 410 mg (0.10.25 mL). Tendon sheath or bursa injections usually use 430 mg. For example, a knee might receive 40 mg once, while an inflamed finger joint might get 5 mg. Practitioners often aspirate synovial fluid first to confirm needle placement, then inject Depo-Medrol into the joint space. The joint is gently moved afterward to mix the steroid suspension. Repeat injections (if needed) are typically spaced by several weeks (e.g. 46 weeks) to monitor response and avoid excess steroid exposure