Sepriano A, Ramiro S, Wichuk S, et al. - This study was carried out to assess if tumor necrosis factor inhibitors (TNFi) impact spinal radiographic progression in patients with axial spondyloarthritis (SpA) and whether this is coupled to their effect on inflammation. Researchers enrolled individuals with axial SpA fulfilling the modified New York criteria in a prospective cohort (the ALBERTA Follow-Up Research Cohort in Ankylosing Spondylitis Treatment). Using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), spine radiographs, performed every 2 years for up to 10 years, were scored by 2 central readers. They tested the indirect effect of TNFi on mSASSS with generalized estimating equations by testing the interaction between TNFi and Ankylosing Spondylitis Disease Activity Score (ASDAS) at the start of each 2-year interval (t). The relationship between TNFi at t and mSASSS at t+1 (adjusting for ASDAS at t) was also evaluated (direct effect). A total of 314 individuals were enrolled in this study. The data demonstrate that in patients with radiographic axial SpA, TNFi decreases spinal radiographic progression, which might be partially uncoupled from their effects on inflammation as measured by the ASDAS.