Axial spondyloarthritis (axSpA) isn't just about back pain; it's about long-term disability prevention. The ASAS criteria highlight the importance of early diagnosis, yet many still rely on old imaging techniques that miss subtle changes. The 2022 METEOR trial showed that MRI can detect inflammation far earlier than conventional X-rays, leading to timely interventions. If we're not using cutting-edge imaging, we're failing our patients. We need to shift our approach—let's start prioritizing early imaging in axSpA assessments. Your patients depend on it.