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Alterations in somatomedin can result in growth hormone deficiency with two known mechanisms
And it is only a reliable indicator of B12 status when the persons folate is normal (above 4 ng/mL)
Since he seemed initially to benefit from this treatment, it is still possible that he was deficient
PMID 23356638
Treatment Failure With Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Patients
It potentially reduces excessive inflammatory responses, which prevents tissue damage
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