TNF and obesity due to melanocortin 4 receptor deficiency: Obesity contributes to this pro-inflammatory milieu by promoting the release of cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP), which may adversely affect both the synovial environment and the fibrotic response within the joint capsule [28,29].