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If methotrexate plus glucocorticoid is insufficient, any bDMARDs or tsDMARDs can be recommended to add to csDMARDs, such as methotrexate plus tocilizumab, methotrexate plus rituximab, methotrexate plus tofacitinib, and so on (15)

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Even though your lab tests arent a slam dunk for B12 deficiency, you can read between the lines and make the assumption that you are probably not getting enough B12

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Do not start or stop any medication or supplement during pregnancy without first consulting with your doctor to ensure the safety of both you and your baby

In both cases, gently swirl the bottle to homogenizenever shake vigorously to avoid denaturation or oxidation