Summary Background Rheumatology practice has seen an increasing development and use of scores to assess disease activity, loss of physical function, quality of life and radiographic damage. Study results, in particular for rheumatoid arthritis, demonstrate that target-oriented treatment concepts using scores lead to improved treatment results (Treat-to-Target). Objective To review how frequently scores are used in daily rheumatological practice to assess disease activity, loss of physical function and treatment response in patients with ankylosing spondylitis and how much treatment decisions are influenced by the use of these scores. Methods A Germany-wide prospective multicentre study 74 sites (61 rheumatologists in private practice and 13 hospital-based rheumatologists) documented the use of scores for assessing disease activity, treatment response, quality of life and imaging results in patients with ankylosing spondylitis (AS) (18–83 years) over 3 consecutive visits. A total of 1 476 fully evaluable visits of 492 patients [326 (66.26%) men and 166 (33.74%) women] were recorded. Results The most commonly used scores were BASDAI (n=1.134, 84% of all visits) and BASFI (n=500, 37.5%). At least one score was calculated in 1.335 visits (90.45%); a combination of several scores was calculated in 748 visits (50.68%). Only in 141 visits (9.55%) no scores were calculated at all. Scores were used independently of patients’ age, duration of treatment, medication, and treatment changes and region of the participating rheumatologist. Scores recording treatment response (ASAS response) or quality of life were recorded in a few cases only. The average influence of a score on a treatment decision was 5.67 on a scale from 0 to 10.