Sepriano A, Ramiro S, Landewé R, et al. - This study was undertaken to investigate the effect of inflammation on MRI‐structural changes occurring in the sacroiliac joints (SIJ) and the spine. Researchers enrolled patients with early axial spondyloarthritis (axSpA) from the DESIR cohort. Via three central readers, MRIs of the SIJ (MRI‐SIJ) and spine (MRI‐spine), obtained at baseline, 2, and 5 years, were scored. They characterized inflammation and structural damage on MRI‐SIJ/MRI‐spine by the agreement of ≥ 2 of 3 readers (binary outcomes), and by the average of 3 readers (continuous outcomes). A total of 202 patients were recruited in the study. In patients with early axSpA, a predictive and longitudinal association was found between MRI‐inflammation and several types of MRI‐structural damage which adds to the proof for a causal relationship.