Sepriano A, Ramiro S, Wichuk S, et al. - This study was carried out to assess if TNF inhibitors (TNFi) impact spinal radiographic progression in patients with axial spondyloarthritis (axSpA) and whether this is coupled to their effect on inflammation. A prospective cohort (ALBERTA FORCAST) was conducted including patients with axSpA fulfilling the modified New York criteria. Using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), spine radiographs, done every 2 years up to 10 years, were scored by 2 central readers. Researchers assessed the indirect effect of TNFi on mSASSS with generalized estimating equations by testing the interaction between TNFi and ASDAS at the start of each 2‐year interval (t). A total of 314 patients were included in the study. In patients with radiographic axSpA, TNFi decreases spinal radiographic progression which might be partially uncoupled from their effects on ASDAS inflammation.