This study aims to understand patient decision-making in Axial Spondyloarthritis (axSpA) and explore how decision-making, treatment satisfaction, and biologic disease modifying antirheumatic drugs (bDMARDs) may be related. This study included 274 participants from the ArthritisPower research registry who completed an online survey about their axSpA treatment and most recent physician visit. Researchers found that three-fifths of participants discussed a treatment change with their physician at their last visit, and most agreed to the change, most often treatment escalation. Participants currently using bDMARDs reported higher satisfaction overall and highlighted the prevention of long-term damage from axSpA and their doctor’s advice as among the most important factors in their decision-making about axSpA treatment. Patients’ treatment concerns and preferences include a desire for better, more lasting control over symptoms.