Immune‐mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)‐α‐mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case–control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random‐effects meta‐analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non‐biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta‐analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58–0.95, p = 0.025; IRR = 0.77, 95% CI 0.67–0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi‐treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64–0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.

Background: Current therapeutic guidelines for immune‐mediated inflammatory diseases (IMIDs) contraindicate the administration of tumour necrosis factor inhibitors (TNFis) in advanced heart failure (HF) and highlight the potential risk for new‐onset HF. The current evidence has low certainty, and the results of studies in the past two decades have even challenged the recommendations regarding the impact of TNFis on the risk of HF.Objectives: The objective was to systematically synthesize data on the risk of HF in TNFi‐treated groups compared to non‐treated controls in IMIDs.Methods: A systematic search was conducted in August 2023. Randomized controlled trials (RCTs) and non‐randomized observational studies of IMID patients comparing groups receiving TNFis to non‐TNFi‐exposed controls were included. The outcome was the incidence of worsening, de novo, and composite HF. Random‐effects meta‐analysis was conducted using risk ratios (RR) with 95% confidence intervals (CIs) to pool data.Results: The systematic search identified 49 studies, with 45 included in the quantitative analysis. For the worsening of HF, the pooled results of non‐randomized studies showed no statistically significant risk‐increasing effect of TNFis (RR = 1.18, 95% CI: 0.69–2.00). Analyses from both RCTs and non‐randomized data indicated no increased risk of de novo HF in the TNFi‐group compared to controls (RR = 0.87, 95% CI: 0.60–1.25 and RR = 0.86, 95% CI: 0.64–1.14, respectively). Similarly, no increased risk was found for composite (worsening and de novo) HF in the TNFi‐treated group versus controls, pooling non‐randomized data.Conclusions: Our findings indicate that TNFi‐treated IMID patients do not have an increased risk for developing de novo HF, and no statistically significant risk enhancement could be observed in the risk of worsening HF with TNFis. Updating IMID guidelines should be considered regarding TNFis' non‐risk increasing effect on de novo HF, whereas further validating data on the risk of worsening HF in TNFi‐treated IMID patients is needed.

The shoulder is the most commonly dislocated joint, with a recurrence rate of up to 100 % in the untreated young population. However, a clear and universally accepted treatment guideline is still missing. Our study aimed to provide an international literature review that could help find the most effective therapy. We comprehensively searched three databases (PubMed, Embase, and Cochrane), including 19 randomized controlled trials. Based on these, we conducted a network meta-analysis to examine the success rates of three different treatment methods after first-time acute anterior shoulder dislocation: fixation in internal rotation (IR imm), external rotation (ER imm), and arthroscopic Bankart (Art Bkrt) surgery. The main focus of our study was the safety and efficacy of the different therapies. The risk of bias was assessed using Rob2. Outcome measures were standardized mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data. P score for redislocation was significantly higher in the arthroscopic Bankart group, reaching 0.9994 compared to the values of the external rotation and internal rotation groups (p = 0.3012, p = 0.1994, respectively). The same results were obtained for subluxation and residual feeling of instability, favoring arthroscopic Bankart repair against conservative treatment options. Arthroscopic Bankart surgery has the best success rate for first-time anterior shoulder dislocation without significant bone loss in terms of redislocation, subluxation, and instability. Conservative treatments provide inferior results. To our knowledge, the most common international treatment methods for acute first-time anterior shoulder dislocations without significant bone loss have not yet been compared. Based on our study, the Bankart procedure is more effective than conservative treatment in preventing recurrence, especially after a 24-month follow-up period. In contrast, the results achieved with external rotation fixation are significantly weaker, while the effectiveness of internal rotation fixation is significantly lower than that of surgical intervention.

Background/Objectives: MRI FLAIR signal serves as a time surrogate in unknown onset strokes; however, its prognostic value in early known-onset strokes treated with intravenous thrombolysis (IVT) remains unclear. We aim to evaluate whether FLAIR positivity predicts hemorrhagic transformation and less favorable functional outcome following IVT within 4.5 h of symptom onset. Methods: A systematic search of Embase, PubMed, and Cochrane Library was conducted. We included studies reporting 90-day functional outcome and hemorrhagic transformation after intravenous thrombolysis within 4.5 h of symptom onset in relation to the FLAIR signal on pre-treatment MRI. Two reviewers independently extracted data and assessed bias using QUIPS. A random-effects model was used for meta-analysis. The study protocol was registered in PROSPERO (CRD42023486781). Results: Six studies comprising 951 patients were included in the final analysis. Patients with FLAIR-positive lesions (25.86%) had non-significantly higher odds of hemorrhagic transformation (OR, 3.47; 95% CI, 0.51–23.57; p = 0.131) and significantly higher odds of unfavorable 90-day outcome (OR, 2.14; 95% CI, 1.01–4.55; p = 0.049). The pooled sensitivity and specificity of FLAIR status for predicting hemorrhagic transformation were 41.2% and 82.1%. The pooled sensitivity and specificity of FLAIR status for predicting less favorable outcome were 40.9% and 78.1%, respectively. Conclusions: FLAIR positivity is significantly associated with less favorable 90-day functional outcome and a trend toward a higher rate of hemorrhagic transformation following IVT within 4.5 h of symptom onset. It may aid risk stratification but should not preclude treatment in eligible patients.