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(See Figure 4 for overall approach to treatment and prevention of gout.) Treatments used for prevention, such as allopurinol (see below) can actually make things worse if given during a flare, and so need to be held back until the flare has resolved for several weeks

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the MHRA advises checking vitamin B12 levels if deficiency is suspected and considering periodic monitoring in those with risk factors [6] Chronic alcohol consumption can damage the gastric mucosa and impair absorption Nitrous oxide exposure (including recreational use) can inactivate vitamin B12 in the body, causing functional deficiency and neurological symptoms If you experience symptoms such as unexplained fatigue, pale skin, shortness of breath, neurological symptoms (tingling, numbness, balance problems), mood changes, or cognitive difficulties, contact your GP promptly

No, lupus is a disease of the immune system

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