A. Mean HSS by time period, stratified by ever having biologics and/or surgery. The effect of ever having biologics on the slope of HSS score over time varied significantly, depending on whether the patient ever had surgery (p-value for Biologic × period × surgery interaction <.0001, after adjusting for baseline HSS in mixed model regression). Just comparing those who ever received biologics without ever receiving surgery (BIOL-SURG) versus those who received both, the difference was significant (p=.003): those who received both declined faster than those who received biologics only. B. Mean AN count by time period, stratified by treatment combination. The effect of ever having biologics varied significantly, depending on whether or not the patient ever had surgery (biologic-ever × time period × surgery-ever interaction p<.0001). Patients with biologics only had a rebound in AN count in Yr2 and Yr3+, while those who also had surgery continued to show decline in AN count in Yr2 and Yr3+.