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For advanced osteoarthritis involving the entire joint, supplement local injections with a systemic abdominal injection (split the daily dose)

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Hydroxocobalamin is the standard UK preparation, administered intramuscularly for conditions like pernicious anaemia and gastrointestinal malabsorption B12 acts as a cofactor in DNA synthesis, red blood cell formation, and nervous system function, supporting energy metabolism pathways Common side effects include injection site reactions, mild gastrointestinal upset, and temporary urine discolouration, with serious reactions being rare NHS access requires GP assessment with blood tests

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The timing of B12 supplementation is generally flexible and should be guided by personal preference and tolerability