Year in Review: Axial Spondyloarthritis

Axial spondyloarthritis is a chronic inflammatory disease primarily affecting the sacroiliac joints and spine. Over the past two years, significant progress has been made across multiple domains of spondyloarthritis research. The current review critically summarises key advancements in research during 2024-2025, covering pathophysiology, epidemiology, diagnosis, imaging, and clinical management. Notable findings include novel immune stromal interactions, such as IL-17 extracellular vesicles, IL-33 induced TREM2⁺ macrophages and disease specific CD8⁺ T cell responses that provide insight into bone remodelling and inflammation. Epidemiological data confirm persistent diagnostic delays, though targeted referral strategies show promise. Advances in imaging include an international consensus on MRI protocols and the growing use of ultrasound for the assessment of enthesitis. Artificial intelligence models demonstrate strong performance in early diagnosis, imaging interpretation and disease activity prediction and prognosis, while advances in therapy include the first head-to-head trial and numerous real-world data.