Hidradenitis Suppurativa

A 28-year-old woman with a 6-year history of hidradenitis suppurativa presents with recurrent, painful inflammatory nodules and purulent drainage from sinus tracts in the bilateral axillae and inguinal folds. She has tried topical clindamycin, oral doxycycline, and hormonal therapy without sustained improvement. Examination reveals multiple interconnected sinus tracts with rope-like scarring consistent with Hurley stage III disease. Her BMI is 32 kg/m², and she continues to smoke 15 cigarettes daily. The treatment approach marked **A** in the diagram—combining adalimumab (anti-TNF biologic) with wide surgical excision—is indicated. Which of the following best explains why TNF-α inhibition is effective in this patient's condition?