The concept of disease modification refers to interventions that affect the underlying pathophysiology of the disease, altering its natural course, resulting in long-term control and improved outcomes for patients [1,2]. There are numerous definitions of disease modification across various chronic diseases, particularly those characterized by inflammation or progressive structural damage. Disease modification in axial spondyloarthritis (axSpA) includes therapeutic strategies targeted at altering the natural course of the disease and slowing down its progression with the aim of, long-term control of inflammation, symptom reduction, preservation of joint function, and prevention of structural damage, including bone loss and new bone formation [3,4].

For this review, we will primarily discuss structural damage and progression as the main objectives of disease modification in axSpA. The focus will be on the use of imaging studies (from our current therapeutic options) in the assessment of disease progression and disease modification.