Toe arthrosis medication treatment

Numerous 26-bone joints make up our foot. Each such joint can undergo osteoarthritic changes, but arthrosis of the toes is often diagnosed. Osteoarthritis of the toes affects the digital phalanx with metatarsophalangeal, interphalangeal joints.

Often there is a defeat of the big toe, no less goes to the little finger. In rare cases, damage to the second finger occurs. Osteoarthritis of the toes will be accompanied by pain, the gait of a person will change over time. A complete cure for arthrosis of the joints is impossible, but pathology can be stopped, minimized complicated conditions.

Causes

Osteoarthritis of the joint of the big toe, like other arthritic changes, is caused by trauma to tissue structures, an age-related feature of the body, impaired metabolic processes, and exhausting physical work. If the causes of arthritic changes in the big toe cannot be determined, then the pathology is primary. Most at risk of developing primary arthrosis:

  • Old men.
  • Women during menopause.
  • Patients with burdened heredity.
  • People who are professionally involved in sports, who work intensively physically, whose work is associated with prolonged standing.

Secondary osteoarthritic changes in the joints of the toes are formed against infections, pathological processes, due to which the joints are destroyed by toxic compounds. Failure of the endocrine organs with an imbalance of hormones will lead to the fact that destructive changes in cartilage will prevail over the recovery processes. With an impaired metabolism by the body, the compounds that are necessary for the restoration of cartilage and bones are not synthesized enough.

Osteoarthritis of the first and other fingers affects overweight patients, since they have a metabolic disorder, tension on the lower extremities will be great. Osteoarthrosis of the big toe caused by trauma occurs due to the fact that the joint tissue is physically damaged, there was a severe bruise with dislocation of the toe. Osteoarthritis of the first toe or several toes may occur due to injured knees, ankle joints. Therefore, small joints will be overloaded.

Often arthrosis of the phalanx of the toes occurs due to the fact that a person wears uncomfortable shoes, which is caused by squeezing the feet, also problems will arise in those who like to walk in high heels. Arthrosis occurs due to flat feet, clubfoot, anomalous structure of the soles. Violation of microcirculation will lead to a lack of nutrients in the joint tissues.

Development mechanism

Destructive changes take place in several stages. First, there is a violation of phosphorus and calcium metabolism, joints will experience a deficiency of nutrients. The joint will no longer perform the depreciation function, the cartilage is loosened, they decompose into fibers. Then the compaction of the joint capsule begins, the synovial cerebrospinal fluid is synthesized in a smaller volume. When the pathology progresses, osteophyte formations will form.

If there is no treatment, inflammation will join. Fragments of cartilage that underwent destruction, penetrate into the synovial cerebrospinal fluid. During the movements, the joint capsule and adjacent tissue structures are injured, acute inflammation occurs. The affected area will become swollen, there is hyperemia, hyperthermia, pain.

Symptoms

Symptoms of arthrosis depend on the severity of the pathological process. At the initial stages of the pathology, the patient is uncomfortable while walking, his movements are constrained, his joints crack. Symptoms progresses during motor activity, decreases in a calm state. With the progress of the pathological process, the pain syndrome is constantly observed, does not disappear even at night.

Motor activity is severely limited. In severe cases, complications of the pathology occur, the inflammatory process joins, the skin becomes hyperemic, if you feel it, it is hot. The disease damages the joint tissues to their complete destruction.

There are 4 degrees of pathological changes:

  • At the initial stage of the disease, the patient is a little uncomfortable during loads of the sole. The patient thinks his legs are tired. At this stage, the pathology can be completely cured.
  • At stage 2, the metatarsal head becomes enlarged. There is a pain syndrome, deformation of 1 finger is observed. When a person walks, his joints crackle. On examination, they are sealed. Finger stiffness will pass in about 1 hour. The affected area is swollen, it is hot, hyperemic. The patient becomes worse, he may experience hyperthermia.
  • At the next stage of the pathology, the motor function is partially lost, the person’s gait is changed, pain is observed almost constantly. Cartilage between the phalanges is almost completely deformed. Pain can remain even after treatment with drugs. On the thumb, deformation in the form of a cone is observed. With movements, the joints are constrained, a person suffers from pain.
  • At the last stage, the motor function of the joint is completely lost, only surgery can help the patient.

Diagnostics

At the first degree of pathology, it is sometimes not possible to establish an accurate diagnosis, since the symptoms are smoothed out. Differentially compared with other articular pathologies. Finger arthrosis is distinguished from gout, rheumatoid and reactive arthritis. If urine contains urate, then the patient suffers from gout. Rheumatoid factor in arthrosis should not be observed.

At the initial stage of the pathological process, an x-ray will show a narrowed gap in the joint, and bone density has been reduced. Over time, with the progress of the pathology, osteophytes are visible on the radiograph, the joint space is completely absent, ankylosis is formed. MRI, CT are used in preparation for surgical intervention. To determine bone density, exclude osteoporosis, densitometry is used.

Complications

The mobility of the foot may be lost in whole or in part. A periarticular bag can become inflamed, a combined arthrosis with the defeat of other toes can form. The thumb may be deformed, the patient will limp.

Osteoarthritis on the toes

The deforming process in the joints affects almost every person over 60 years old. Osteoarthritis of the toes is characterized by the destruction of the cartilage tissue of the joint, with concomitant inflammation of the soft tissues. Bone deformation often leads to loss of ability to move normally. Often arthrosis of the thumb and little finger occurs, less often the damage to the joints of the second finger is diagnosed. The treatment of arthrosis of the toe implies drug therapy and special exercises.

Causes of pathology

Arthrosis leads to loss of joint mobility and constant pain, which is why a person cannot walk normally.

Most often, cartilage tissue suffers due to increased load, which is caused by the following factors:

  • long walks;
  • excessive body weight;
  • the use of uncomfortable shoes;
  • frequent hypothermia;
  • professional dance lesson;
  • trauma;
  • hormonal disorders.

Concomitant diseases disrupt the blood supply to the toes, which is why the cartilage tissue of the joints becomes thinner, loses its natural elasticity and becomes covered with cracks. The greatest threat is posed by pathologies such as:

Main symptoms

The clinical picture of toe arthrosis is aggravated as the disease develops, and is divided into 4 degrees:

  • First stage. Damage to the joint of the thumb is manifested by minor pain and stiffness. Symptoms of this kind usually do not bother the patient, and necessary therapy is often delayed.
  • Second degree. Arthrosis of the foot is accompanied by a crunch that is heard while walking. The pain syndrome intensifies, signs of inflammation appear, such as swelling and hyperemia of the skin of a sick finger.
  • Third stage. With a disease of 3 tbsp. faced by people neglecting treatment. Arthrosis is manifested by severe round-the-clock pain, overgrowth of bones and deformation of the fingers. Similar symptoms lead to lameness.
  • Fourth degree. At the last stage of the development of toe arthrosis, all clinical manifestations of the disease are amplified. The joint is destroyed so that the only way to restore it is endoprosthetics.

Diagnosis of arthrosis of the toes

If you experience any symptoms that indicate inflammation in the joints of the foot, you need to see a general practitioner. After a general examination, the doctor will give a referral to a specialist with a narrow profile, for example, to a rheumatologist or arthrologist. To identify arthrosis, it is enough to evaluate the visible manifestations of the disease, to palpate. To confirm the diagnosis and differential diagnosis, such research methods are used as:

A biochemical blood test helps to identify or disprove the development of gout.

  • Roentgenography. Indicates the size of the joint spaces, the presence of osteophytes and changes in bone structure.
  • Blood biochemistry. Detects the presence of inflammation in the body and signs of gout.
  • Densitometry. Estimates bone density. With arthrosis, the areas of bone located under the cartilage are compacted. If the bone structures look translucent, the cause of the pain is osteoporosis.

For the effective treatment of arthrosis, it is necessary to identify and eliminate the cause that provoked damage to the cartilage tissue of the toes.

What treatment is prescribed?

It is necessary to treat arthrosis of the joints of the toes at the initial stages of development, while the cartilage tissue can be affected. Therapy should be comprehensive. A number of medications are used for internal use, warming ointments, physiotherapy exercises. At the same time, it is important to observe the drinking regimen when drinking at least 1,5 liters of water per day, since dehydration negatively affects the elasticity of the cartilage.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Medication Therapy

Arthrosis of the joints of the toes is treated with chondroprotectors. The effect of the drug appears after 2-4 months. With its help, damaged cartilage is restored, bone friction and the inflammatory process are eliminated. At the last stages of the development of finger arthrosis, it is impossible to restore the cartilage to a normal state, the problem can only be eliminated with the help of surgery. In addition, with damage to the toes by arthrosis, the patient is prescribed drugs of such groups as:

  • NSAIDs;
  • hyaluronic acid medicines;
  • analgesics;
  • warming ointments.

Therapeutic exercises

Gymnastics helps restore mobility to the sore joints of the toes, and strengthens muscle tissue, preventing the development of atrophy. Classes should be daily. The doctor selects the course of exercises individually, since any improper movement can aggravate the course of the disease. The following recommendations are given for restoration of joints with arthrosis of the foot:

  • walk barefoot;
  • roll pencils on the floor with your toes;
  • use a rubber band for training.

Manual therapy

During the studies, it was found that arthrosis of the foot is accompanied by a number of skeletal pathologies, spinal lesions in different segments, pelvic distortion, flat feet, etc. Therefore, the effect is not only on joints affected by inflammation, but also on all sections of the musculoskeletal system. This starts the process of tissue self-healing, normalizes metabolic processes, activates the regeneration of damaged cartilage.

Treatment with folk remedies

Therapeutic methods based on medicinal herbs are an auxiliary, and not the main tool in the fight against arthrosis. Before using them, you need to consult your doctor and make sure that there are no allergies to the components of the selected recipe. Treatment with folk remedies allows you to relieve inflammation and pain. The following tools are recommended for this:

  • Compresses with fresh burdock leaves.
  • Baths and lotions with decoctions of St. John’s wort, thyme, violet tricolor.
  • Grinding of joints with alcohol infusion of eucalyptus.
  • Compresses with pre-steamed hop cones, chamomile flowers, elderberry leaves.

Physiotherapy

Due to the physiotherapeutic effect in sick joints, blood circulation improves, metabolic processes are normalized, damaged tissues receive the necessary nutrients. Patients with arthrosis of the toes are prescribed:

  • UHF Restores blood supply to inflamed areas and eliminates pain.
  • Electrophoresis Promotes the rapid absorption of drugs.
  • Magnetotherapy. Eliminates inflammation and pain.

To prevent the development of arthrosis of the toes, you need to choose comfortable shoes, lead an active lifestyle and periodically undergo a medical examination.

When is the operation performed?

Surgical intervention is prescribed in severe cases, if conservative treatment does not give results, and does not allow to eliminate pain, as well as in case of bone deformation and complete destruction of the cartilage tissue. The type of operation is selected depending on the degree of damage to the joint. Full or partial excision of deformed bones and their replacement with prostheses is possible. Damaged cartilage layers are replaced with pieces of patient skin. The defeat of arthrosis of the joints of the foot can lead to a change in gait, but disability is not assigned to a person.

Osteoarthritis of the toes

Osteoarthritis of the toes – a common disease of the musculoskeletal system, often affects older people, but also occurs in young people.

Its degenerative-dystrophic nature is associated with a violation of the metabolic processes of the cartilage tissue of the finger joints.

As a result of this, not only its destruction, thinning and loss develops, but also the degeneration of the whole organ of movement.

In this case, bone and soft tissue grows and gradually all of its parts are affected, including the subchondral bone, ligaments and periarticular muscles. With the onset of degenerative changes, disturbances in the oxidative processes in the cartilage also occur with the loss of fluid in its composition.

This complicates the movement and leads to its further destruction.

Factors and causes of arthrosis of the joints of the toes

The development of arthrosis begins after exposure to factors that disrupt the normal metabolism of cartilage.

Arthrosis is divided into 2 types – primary and secondary.

The first appears in previously healthy fingers of the joint, the second develops in those that had previous pathologies.

The cause of the disease may be:

  • Narrow, tight shoes, very high heels;
  • Injuries to the legs, especially toes;
  • Flat feet, clubfoot;
  • Hypothermia;
  • Long stays in connection with professional activities;
  • Constant load on the legs due to excess weight or sports;
  • Vascular disease of the legs;
  • Metabolic pathology;
  • Endocrine diseases;
  • Source of infection in the body;
  • Arthritis and arthrosis of other joints;
  • A state of prolonged stress.

Medicine takes heredity into account in this. But it cannot be the root cause, because it means only predisposition.

Symptoms

There are a number of symptoms that are always present with arthrosis. Also, all varieties of the disease have their own characteristic symptoms.

  1. Soreness in the fingers;
  2. Pronounced crunch (crepitus);
  3. Stiffness;
  4. Deformation.

Pain is present from the very beginning of the disease. In the first stage, when the destructive processes are just beginning, they are not very pronounced.

With aggravation of the state, they intensify and become continuous.

During movement and load on the legs, pain is always present. This is caused by the presence of inflammation of the affected organ of movement. When lying down, these sensations subside.

In the third stage, the pain does not stop even at rest. If damage to the joints occurs in parallel with circulatory disorders, pain does not disappear at night.

A characteristic sign of the disease is a specific dry crunch during movement, which is inseparable from pain and discomfort.

It differs from clicking healthy fingers. In the initial period, it is weakly manifested, but with the progress of the disease it becomes loud and clear. This is due to the friction of rough destroyed joint surfaces.

During the aggravation of finger degeneration, a significant decrease in their mobility is noted. This is due to the growth of bone tissue in the form of processes of various shapes (osteophytes), the absence of synovial fluid, narrowing of the joint gap to a minimum or complete disappearance, cramps of the periarticular muscles.

Deformation changes occur due to the formation of osteophytes and alterations of bones connected in this organ of movement.

Severity in the development of the disease

In addition to the common signs of each of the 3 degrees of severity during arthrosis of the toes, there are individual, unique to it. Characteristic is the simultaneous defeat of all the fingers of the lower extremities.

In the first degree – slight pain occurs, sometimes there is a slight stiffness in the entire foot. This does not cause special problems during movement or loads on the limbs, therefore, they often remain unattended.

In the second degree – goes untreated, developing pathological process. Substantial stiffness appears, cracking is heard when walking. Pain sensations intensify. Swelling is observed in the area of ​​the fingers, inflammation is expressed by hyperemia (redness), body temperature may increase, muscle atrophy is noted.

Irregularities in treatment or its absence leads to a third degree of severity. In this case, the pain intensifies and does not pass either day or night. Bone tissue grows intensively, which leads to joint deformation and a change in the length of the fingers.

Deformation changes of all toes are visually noticeable. At the edges of the fingers, thickenings are felt. Mobility is so limited that it can lead to immobility of the entire foot. Lameness appears.

Sometimes the fourth degree of the disease manifests itself when complete destruction of the joint occurs. In this case, it is necessary to replace it with an endoprosthesis.

How is arthrosis of the toes treated?

Arthrosis has been known for a long time, in medicine there have developed traditional schemes for its treatment, to which additional methods are added.

They are complex, aimed at suppressing inflammatory processes, pain, restoring the tissues of the affected joint, improving blood circulation and metabolic processes in them, restoring its functions, strengthening ligaments and muscles, eliminating the causes of degenerative – dystrophic changes.

Such a medical complex consists of medications, physiotherapy, massage, exercise therapy (physiotherapy exercises).

Appointments are carried out in accordance with the severity of the patient’s condition, his age and the presence of other diagnoses, complete rest is prescribed.

In the acute period, non-hormonal (non-steroidal) drugs are prescribed to relieve inflammation and achieve pain relief.

In order to improve the result, non-steroidal anti-inflammatory ointments and gels are added. For independent use, they are not effective enough, but work well together with injection forms and tablets.

Medicines, the main active ingredient of which are corticosteroid hormones, are used in the acute period as anti-inflammatory drugs and analgesics. They quickly relieve pain, inflammation and swelling, but at the same time contribute to the destruction of cartilage.

Therefore, they are prescribed limitedly and for short periods, often injections into a sore finger. This is a complex painful procedure, requires skill and is used with great care.

For this, Kenalog, Hydrocortisone, Metipred, a drug based on hyaluronic acid – Ostenil can be used.

Chondroprotectors are medicines that are not aimed at individual symptoms, but at restoring a damaged joint. They contain substances that make up healthy cartilage, and they are intended for prolonged use – up to 2 months.

The most applicable – Mucosat, Dona, Teraflex, Rumalon and others.

At present, third-generation chondroprotectors containing several active substances are widely used. They are released for oral administration, for injection and ointment, creams, gels – externally.

For severe pain, blockages are used with anesthetics.

The role of physiotherapy, massage and exercise therapy in recovery

These methods begin to be used only after the symptoms of the acute period are removed and remission begins. They are aimed at consolidating the achieved effects – the maximum restoration of tissues and joint functions and the prevention of a new exacerbation.

In order to treat electric energy, they use UHF therapy, which improves blood supply and metabolic processes, suppresses inflammation and pain.

Magnetotherapy inhibits inflammation and pain by the action of a magnetic field on the affected organ.

Electrophoresis promotes the qualitative administration of drugs through the skin using electric current for the early onset of analgesic effects.

High-frequency ultrasonic vibrations at the basis of ultrasound therapy help the human body activate activation and defense systems, which is very important in the treatment of arthrosis of the toes.

Massage of the lower limb will strengthen muscles, improve blood circulation, metabolism, activate the elimination of toxins and harmful substances, strengthen the body’s defenses and promote recovery.

Exercise therapy will help restore joint mobility and strengthen leg muscles. The correct selection of exercises can only be done by a specialist.

ethnoscience

Traditional medicine for many years successfully treat diseases of the lower extremities. These are mainly compresses, grindings, lotions, baths from tinctures and decoctions made from herbs, various plants and natural products.

Everyone knows the anti-inflammatory analgesic effect of compresses from fresh burdock leaves. It is useful to add honey to infusions and decoctions, and to use beekeeping products.

Anti-inflammatory and analgesic properties have baths and lotions from thyme, tricolor violet, juniper, St. John’s wort. Alcohol compresses work well, especially with honey. Grinding from tincture of eucalyptus on alcohol, vodka or moonshine is effective.

It must be remembered that these are only additional methods of treatment and without the main one – the disease can not be cured.

Arthrosis is easier to prevent than to treat.

Therefore, properly selected comfortable shoes, avoiding heavy loads on the legs, a healthy lifestyle, and timely treatment and prevention of any diseases will be the key to health for many years.

Ointments for foot arthrosis

Feeling pain in the joint, we go to the pharmacy and buy anesthetic ointment. The decision is right, especially since ointments for foot arthrosis are among the effective means against pain and inflammation. The advantage of the ointment is that, unlike tablets that enter the stomach, it does not cause serious side effects and is easier to tolerate by the body. In addition, an external agent is applied to the joint area and acts faster than drugs in the form of tablets.

What ointments are used for arthrosis of the foot?

In order to decide which ointment for arthrosis of the foot is necessary for the patient, the doctor takes into account the degree of the disease, the revealed symptoms and the features of his health. In pharmacies, drugs of various actions are sold, which are divided into:

For many years, unsuccessfully struggling with pain in the joints.

Read the article where I told HOW I CURE JOINTS using four plants and Soviet technology of the 83rd year

    anti-inflammatory, non-stero >For patients to correctly choose an ointment for foot arthrosis, reviews and a review of drugs are important. The expert opinion on arthrosis and its treatment can be viewed here:
    Let us dwell on the features of each of the types of external funds.

Anti-inflammatory ointments for foot arthrosis

As a rule, inflammation in the affected joint is formed during exacerbation of the disease. The task of the ointment is to stop this process and reduce the pain syndrome. Manufacturers offer products based on such active substances as ibuprofen, ketoprofen, diclofenac. Apply ointments for 2-3 weeks, applying to the affected areas 2-3 times a day.

The following drugs are considered the most effective and often prescribed:

  • Voltaren Emulgel is an ointment with diclofenac. It relieves pain and stops the inflammatory process. The drug should not be applied if there are various damage to the skin in a sore spot. It is contraindicated during pregnancy and intolerance to the patient’s body of certain substances that make up the drug. In rare cases, a manifestation of allergy has been identified.
  • Dolgit – ibuprofen-based cream. Anesthetizes well, reduces the temperature in the area of ​​inflammation. Do not apply during pregnancy, should be used with caution by people prone to allergies. Do not apply to the skin if it has abrasions and wounds.
  • Quick gel – has high anti-inflammatory properties, effectively relieves pain, relieves inflammation. It is forbidden to use during pregnancy, individual intolerance by the patient of the substances contained in it.

Ointments for warming action

Warming ointments for arthrosis of the joints of the foot are used in order to expand the blood vessels and improve blood flow in them through the warming of the diseased joint. The processes occurring at the same time have a beneficial effect on the joint and muscles, the restoration of diseased tissues is faster.

The range of warming gels and ointments is quite wide. In the pharmacy you can find such drugs as Espol, Nayatoks, Nikofleks, Finalgon. All of them have the same properties, and they include red pepper, bee venom or snakes. Well-proven remedies include:

  • Analgos cream that improves blood supply to the affected area. The drug may cause an allergic reaction. If the dose is exceeded, the temperature rises in the affected area, there is a decrease in pressure in the patient.
  • Espol containing red pepper. For those whose body does not accept substances included in the ointment, it is not recommended to use it, it can cause dry skin and allergies.

Warming agents must be used within a month, only then they give the greatest therapeutic effect. If the patient has signs of side effects of the drug, it should be replaced by another. In the inflammatory process in the articular tissue, warming gels are not used, since their ability to increase blood flow will lead to an exacerbation of inflammation.

Chondroprotectors for external use

Chondroprotectors in the form of ointments serve both as a therapeutic and prophylactic agent. When used to treat foot arthrosis, they help remove pain and swelling. Glucosamine and chondroitin, which are necessary for the construction of cartilage in the human body, are specially introduced into the composition of such agents. The group of drugs is represented by the following means: Chondroitin-Akos, Arthro-Aktiv, Chondroksid, Kondronova, Sustavi-Forte.

Unlike NSAIDs, chondroprotectors work to restore the joint, but they are weak as analgesics. They are not used in the acute period. The general course of treatment can last from 3 weeks to 2 months, everything is decided by the doctor. It is recommended to use such ointments 2-3 times a year, so that beneficial substances accumulate in the cartilage tissue and protect it from destruction. Which ointment to use to treat the affected foot should be decided only by a specialist.

Ointments for improving metabolic processes

It is very important for foot arthrosis to restore metabolism in the affected cartilage and joint. If the process is normalized, tissues receive nutrition faster, blood passes well through the vessels, and the joint receives medications on time. To improve metabolism, ointments with natural ingredients are used. Doctors note that effective ointments for foot arthrosis include: Viprosal B, Apizatron, Kasatsiin.

Apisatron contains bee venom, which has a slight warming effect. Viprosal V cream, which contains snake venom, acts very quickly. After one or two applications, the patient feels a decrease in pain and stiffness. With caution, you should use these funds for those whose skin is highly sensitive to irritating components. More information on the treatment of foot arthrosis is given in this video:

For many years, unsuccessfully struggling with pain in the joints.

Read the article where I told HOW I CURE JOINTS using four plants and Soviet technology of the 83rd year

Cream “Healthy” against foot arthrosis

Among modern means of combating foot arthrosis, specialists and patients unanimously note the high healing effectiveness of the Zdorov natural cream. The complex therapeutic formula of the cream includes such natural components as propolis extract, bee venom, cedar resin, horse chestnut extract, bee morbidity, vitamins, beeswax, beeswax extract. Each of the natural substances has its own tasks.

Propolis extract is able to remove blood clots, strengthen the walls of blood vessels, has a healing and regenerating effect on blood vessels and tissues. Cedar gum revitalizes bone tissue, improves blood flow and stops inflammation. Bee subpestilence helps the inflamed ligaments to bounce back. Vitamins supply the affected area with useful substances, ensuring the strengthening of the cellular structure. An improvement in metabolism is carried out by an extract of beeswax.

The main therapeutic value of the Zdorov cream is that it specifically acts to eliminate the cause of the disease. Its active substances penetrate deep into the affected tissue and work at the molecular level. Horse chestnut extract, for example, effectively affects the blood structure, dilutes it, allows it to move freely through the vessels, and prevents the formation of blood clots. Bee venom helps to remove muscle spasm and increases blood flow in small vessels. Beeswax acts as a natural stimulator of regeneration processes in cartilage and bone tissue.

As you can see, there are many ointments for arthrosis, the choice is wide, but the patient should understand that, only after consulting with a specialist, you can resort to their help. No matter how positive the advertising of funds is, it is better not to self-medicate.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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