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A recent clinical randomized trial study by Filip et al

In addition to acute medicine use (see: Prescribe a NSAID, corticosteroid or colchicine to treat gout flares), encourage rest and elevation of the affected joint, adequate hydration, and some patients may find an ice pack beneficial

MHY884, a newly synthesized tyrosinase inhibitor, suppresses UVB-induced activation of NF-B signaling pathway through the downregulation of oxidative stress

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Agrawal A, Agrawal S, Cao JN, Su H, Osann K, Gupta S

So if you have been off of b12 for a really long time and you're still getting a spike, then see scenario number two and three