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Self-administered B12 shots are generally recommended for individuals: whose bloodwork has documented low B12 levels Patients with pernicious anemia or a lack of intrinsic factor Individuals with Crohn's disease, celiac disease, or post-bariatric surgery malabsorption Vegans and strict vegetarians are unable to correct the deficiency through diet Older adults whose stomach acid production has declined with age Anyone on long-term metformin or proton pump inhibitors Across most of the U.S., injectable B12 is not sold over the counter a clinician has to write the script before a pharmacy can dispense it

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Disease-modifying medications control major flares, but baseline joint stiffness and pain persist, particularly in the hands and wrists