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Musculoskeletal safety signals include cartilage volume loss with repeated intra-articular triamcinolone for knee OA, elevated infection risk around arthroplasty when injections are given close to surgery, and tendon rupture (rare but real)

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Measuring MMA levels improves diagnostic sensitivity and specificity for cobalamin deficiency not only because Hcy elevation can occur in various conditions, but also because approximately 50% of cobalamin-deficient patients may have normal serum cobalamin levels leading to under-diagnosis (Romagnolo et al