Spinal Degenerative Lesions Follow a Predictable Temporal Sequence Over 10 Years in Axial SpA

In axial spondyloarthritis, degenerative spine lesions progress in a specific sequence: MRI disk degeneration strongly predicted later herniation (OR 3.97), Modic type 1 predicted Modic type 2 (OR 49.36), and MRI lesions predicted radiograph lesions at the same level (OR 2.49).

• Prospective cohort secondary analysis of 329 patients (mean age 35 years) from the DESIR cohort, imaged at baseline, 5, and 10 years.
• Disk herniation showed strong persistence over time (OR 184.00; all reported P < .001), highlighting a durable rather than transient lesion.
• Findings are derived from a French axSpA cohort and may not fully generalize to all populations; causal pathways cannot be confirmed from this observational design.

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