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Related Concept Videos

Gastritis-I: Introduction and Types01:27

Gastritis-I: Introduction and Types

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Gastritis, defined by the inflammation or irritation of the stomach lining or gastric mucosa, manifests in several distinct forms: acute, chronic, reactive, and a specific subtype known as autoimmune metaplastic atrophic gastritis.
Acute gastritis presents as a sudden inflammation triggered by various stressors to the stomach lining, such as exposure to corrosive agents, local irritants like aspirin and other NSAIDs, alcohol consumption, radiation therapy, physical trauma, severe burns, sepsis,...
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Gastritis-II: Pathophysiology01:17

Gastritis-II: Pathophysiology

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Gastritis is marked by disruption of the mucosal barrier that usually protects the stomach tissue from digestive juices and manifests in acute and chronic forms.
In acute gastritis, the gastric mucosa becomes swollen and red and undergoes superficial erosion. Superficial ulceration may lead to bleeding.
In chronic gastritis, persistent or repeated insults lead to chronic inflammatory changes and, eventually, thinning or atrophy of the gastric tissue.
Gastritis can stem from various causes, each...
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Gastritis III: Clinical Manifestations and Management01:23

Gastritis III: Clinical Manifestations and Management

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The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
1.0K
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
139
Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
589
Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
311

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Related Experiment Video

Updated: Dec 22, 2025

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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Refractory gout - does it exist?

Werner Löffler1, Lynette Fairbanks2

  • 1Rheumatologie Nymphenburg, Munich, Germany.

Nucleosides, Nucleotides & Nucleic Acids
|May 1, 2020
PubMed
Summary

Refractory gout is often misdiagnosed; most treatment failures stem from patient or physician behavior, not true drug resistance. Improved adherence and physician guidance can effectively manage gout symptoms.

Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Refractory gout (RG) is a recognized clinical challenge, frequently attributed to non-adherence or inadequate dosing.
  • Existing research often fails to distinguish between non-adherence and genuine impaired drug response.

Purpose of the Study:

  • To critically evaluate the concept of refractory gout.
  • To differentiate between patient non-adherence and true impaired response to gout medications.

Main Methods:

  • Review of existing literature on gout treatment and adherence.
  • Analysis of allopurinol's utility in assessing drug response versus adherence.
  • Consideration of recent findings on intensive patient training and supervision.

Main Results:

Keywords:
Enzymologygoutmechanism of action studies

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  • A proposed definition of adherence for allopurinol treatment exists (serum oxipurinol >20 µmol/l).
  • Intensive patient training significantly reduces treatment target failures.
  • Allopurinol serves as a valuable tool for distinguishing non-adherence from impaired drug response.

    • Conclusions:

    • Refractory gout is rare, with most cases attributable to patient or physician behavior.
    • Effective gout management requires addressing adherence and optimizing physician-patient interactions.
    • Metabolic ward studies are necessary only for exceptionally rare cases requiring confirmation of impaired response.