: Objective: To determine the frequency of, and factors associated with, early TNFα antagonist therapy in everyday clinical practice in patients with suspected axial spondyloarthropathy (ax-SpA). Methods: Prospective observational study in the French DESIR cohort of 708 patients with recent-onset (<3 years) inflammatory back pain (IBP) suggesting ax-SpA. TNFα antagonist use was recorded at month (M) 6 and M12 and factors independently associated with TNFα antagonist therapy were identified by multivariate logistic regression. Results: Among the 708 patients (mean age, 33.8 years; 46.2% men), 166 (23.4%) received TNFα antagonist therapy by M12, including 120 (73.6%) who fulfilled ASAS axial criteria and 157 (94.6%) who fulfilled at least one SpA criteria set; 109 (65.6%) had no sacroiliitis. Factors independently associated with early TNFα antagonist therapy were high ASDAS-CRP score (OR1-point increase , 1.60; 95%CI, 1.25;2.03; p<0.001), high physician's global disease activity score (OR, 1.37; 95%CI, 1.21;1.54; p<0.001), ASAS-NSAID score >50 (OR, 1.88; 95%CI, 1.24;2.87; p=0.003), current or past disease-modifying antirheumatic drug use (OR, 2.09; 95%CI, 1.22;3.59; p=0.008), systemic corticosteroid use (OR, 2.48; 95%CI, 1.43;4.34; p=0.002), and mild to severe radiographic hip abnormalities (OR, 9.43; 95%CI, 2.11;42.09; p=0.003). After adjustment on these factors, Achilles enthesis hypervascularisation by power Doppler and number of workdays missed were associated with TNFα antagonist therapy. Conclusion: In DESIR cohort, about ¼ of patients with recent IBP suggestive of axSpA were under anti-TNFα therapy after one year of follow-up. All factors associated with this early initiation reflected higher disease activity, refractoriness, or severity, which suggests compliance of French rheumatologists with current treatment guidelines. © 2014 American College of Rheumatology.