INS and rheumatic disorder: Indeed, both cytokines have been described to reduce the phosphorylation of the Akt signaling and to induce IR in adipocytes.30 31 Moreover, anti-TNF therapy improved insulin sensitivity and reversed defects in the insulin signaling cascade in patients with rheumatic diseases.33 TNF-α and IFN-γ might participate in maintaining local homeostasis, as demonstrated by their elevated levels in the VAT of LC, thus being protective from weight gain.