Signs and symptoms, function and structural damage are treatment targets to modify the course of disease in axial spondyloarthritis (axSpA). Most data are available on the effect of treatment on signs and symptoms. The best treatment effects can be expected both for treatment with NSAIDs and TNF-blockers if patients are treated early in the course of their disease. TNF-blockers are also more effective in patients who have objective signs of inflammation such as positive CRP and/or active bony inflammation on MRI. Recent data indicate that function improves fast and maintains at a good level if disease activity is treated effectively with TNF-blocker over time, even in the case of progression of structural damage. For an effect of TNF-blockers on structural damage an intervention early in the course of the disease seems to be necessary. NSAIDs might also prevent structural damage in axial SpA, although such an effect was not found in all studies. Whether there is a different effect among NSAIDs on prevention of structural is not clear. Drugs targeting IL-17 or IL-23 have also a good effect on signs and symptoms in ax SpA. Their potential effect on other aspects of disease modification is still under investigation. Currently it is not clear, whether a combination of drugs discussed here might have a superior effect on disease modification than treatment with one drug alone.
Disclosure of Interest None declared