[Ankylosing spondylitis is now termined as radiographic axial spondyloarthritis]

The past fifteen years have seen significant changes in the field of spondyloarthritis (SpA). Beyond the change in terminology from ankylosing spondylitis to radiographic axial spondyloarthritis (r-axSpA), advances in pathophysiological insights have highlighted the gut-enthesis axis as a central component of disease development. On the diagnostic front, the introduction of MRI of the sacroiliac joints has been a major advancement, although it has led to an increase in misdiagnoses due to the limited specificity of the technique. From a therapeutic standpoint, biologic treatments targeting TNF and IL-17, as well as Janus kinase inhibitors (JAKi), have brought substantial symptom relief, though they require careful monitoring for infectious risks. Particular attention is given to the risk of venous thromboembolism and cardiovascular events with JAKi. Despite these noteworthy advances, unmet needs remain, especially among patients who are difficult to manage both in terms of inflammation and pain.