Until a decade ago, treatment of ankylosing spondylitis (AS) used to be quite unsatisfactory. However, the advent of TNF blockers has brought about a dramatic change in clinical approach to this disease. The long diagnostic delay- typically 7 to 10 years in the past- is no longer considered acceptable. AS and axial uSpA are probably part of the same disease spectrum. There is great interest currently in making an early diagnosis of AS. The latter would require presence of a combination of several clinical (such as inflammatory back pain, enthesitis, uveitis, or asymmetrical lower extremity arthritis), laboratory (such as HLA-B27 or C-reactive protein), and imaging (X-Rays or MRI) parameters. Although MRI would provide the confirmatory evidence, it may not be necessary in a situation where the probability of axial SpA is already more than 90%. Lastly, it remains to be shown whether early intervention with anti-TNF agents alters the long-term outcome of AS.