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Synovitis—the swelling of the synovial membrane—serves as the front line, where fibroblasts and macrophages swell the ranks, releasing a cytokine storm, in RA, TNF-α, IL-6, and harvesting oxidative stress ‘characters’ all work together as partners in crime to compound and aggravate the situation on the cellular level, as well as at the patient level [5]

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Conclusion This systematic review and meta-analysis indicate that sublingual and oral vitamin B12 administration provide efficacy comparable to intramuscular injection in improving serum cobalamin levels and reducing hyperhomocysteinaemia