What is the evidence that early biologic therapy prevents long‑term structural damage progression in axial spondyloarthritis compared with delayed initiation after conventional treatment failure

What is known

- Anti-TNF, anti-IL-17, and JAK inhibitors have each been associated with reduced radiographic progression of axial spondyloarthritis. ^1,2 - Higher disease activity is linked to more structural spinal damage over time, and a 'window of opportunity' concept is invoked for axSpA. ³ - Early diagnosis and treatment before irreversible changes are described as crucial to prevent structural damage; diagnostic delay is associated with irreversible damage and functional impairment. ⁴ - Reviews propose timely, treat-to-target use of gut-joint therapies to limit structural damage in enteropathic spondyloarthritis. ⁵

What is unknown / caveats

- No excerpt directly compares early versus delayed biologic initiation on long-term structural outcomes - Structural-progression benefit is reported as association, not from a randomized early-vs-delayed trial - The 'window of opportunity' is cited as a concept/rationale, not proven to translate into less damage with earlier biologics - Whether starting biologics earlier rather than after conventional treatment failure actually alters long-term structural damage is not resolved by these excerpts.

## References

1. Bittar M, Deodhar A. Axial Spondyloarthritis: A Review. JAMA. 2025. PMID: 39630439.

2. So J, Tam LS. Precision medicine in axial spondyloarthritis: current opportunities and future perspectives. Ther Adv Musculoskelet Dis. 2024. PMID: 39376594.

3. Wendling D, Hecquet S, Fogel O, Letarouilly JG, Verhoeven F, Pham T, Prati C, Molto A, Goupille P, Dernis E, Saraux A, Ruyssen-Witrand A, Lukas C, Miceli-Richard C, Hudry C, Richette P, Breban M, Gossec L, Dougados M, Claudepierre P. 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine. 2022. PMID: 35038574.

4. Ladehesa-Pineda ML, Ruiz-Vilchez D, Barranco AM, Puche-Larrubia MÁ, Font-Ugalde P, Granados REM, Gratacós-Mastmijà J, Juanola X, Escudero-Contreras A, Collantes-Estévez E, López-Medina C. Association Between Diagnostic Delay and Short-Term Outcomes in Patients with Radiographic Axial Spondyloarthritis: Results from the Regisponser-AS Registry. J Clin Med. 2025. PMID: 40142783.

5. Caso F, Nardone OM, Costa L, Girolimetto N, Cascone M, Schettino A, Saviano A, Scarpa R, Maione F, Giacomelli R, Ruscitti P. The at-risk-to-early continuum of enteropathic spondyloarthritis. Lancet Rheumatol. 2026. PMID: 42330993.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._