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Arthritis Rheumatol (2013) 65(5):13138

Common reasons include: Pernicious anemia , an autoimmune condition affecting intrinsic factor production Gastrointestinal disorders, such as Crohns disease or celiac disease Prolonged use of certain medications, like proton pump inhibitors Knowing these causes helps spot at-risk people

Biomarker-informed approaches incorporating inflammatory markers, cortisol levels, cognitive status, and symptom clustering may further refine patient selection and optimize therapeutic outcomes