SUMMARY Routine detailed gastroenterological investigations were performed in a series of 47 ankylosing spondylitics. Evidence of chronic inflammatory bowel disease was found in eight patients, a prevalence of 17 %. Unsuspected bowel disease was found in the absence of symptoms in three of these patients.The association between ulcerative colitis and ankylosing spondylitis has been well documented.

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Conclusions In our cohort of 167, 62% (n=104) of patients had a TL below the recently published recommended guidelines (5 mg/ml) yet were in a clinical remission. Therefore following these guidelines would lead to a significant increase in drug spend which may not translate into improved clinical outcomes; since in this cohort only 24% with sub-therapeutic levels had active disease. Escalating only those with active disease may represent a more acceptable financial solution but too will lead to an increase in drug spend.