TNF and obesity due to melanocortin 4 receptor deficiency: In a recent review about autoimmune effects of obesity, Versini et al. concluded that the proinflammatory state through increased production of many adipokines including interleukin (IL)-6, tumor necrosis factor (TNF) alpha, resistin and leptin, aggravates the development of PsA and its comorbidities and decreases the efficacy of biologic therapy [32].