Because HA20 patients exhibit excessive production of pro-inflammatory cytokines, biologics targeting cytokines are commonly used as second-line treatments, and primarily include anti-TNF-α (infliximab, adalimumab), anti-IL-1 (anakinra, canakinumab), and anti-IL-6 (tocilizumab) [23], which can effectively inhibit systemic inflammatory responses in patients with HA20. Here, TNF is linked to A20 haploinsufficiency.