Ankylosing spondylitis (AS) is the prototype of spondyloarthritides. The diagnosis of AS is often delayed until late stage with radiographic damage. The development of anti-TNFα therapy has been an important therapeutic advance in AS. The efficacy of anti-TNFα therapy is indubitable in short term and up to five years in published studies in both western countries and Asia. Whether anti-TNFα therapy in AS has disease modifying properties remain unclear. Latent tuberculosis (TB) infection and reactivation of hepatitis B virus infection (HBV) are the major concerns because both TB and HBV are endemic in Asia. Because of the high cost of anti-TNFα therapy, alternative regimens have been adopted in AS patients. Early diagnosis, identify predictive markers and aggressive treatment in early stage of disease in order to alter the disease progression of AS warrant further investigations.