Ankylosing spondylitis (AS) can have important socioeconomic consequences for individual patients and for society, as symptoms usually appear in the third decade of life. When compared with those of the general population, employment rates for AS patients are significantly decreased in men, but not in women; however, both sexes experience increased AS-related (partial) work disability. In addition, changes in type of work, working hours, and the need for help might be required. AS-related sick leave in patients in paid work varies between 6.5 and 18 days per patient per year. Between 15% and 20% of AS patients require help from relatives or friends to complete unpaid tasks. The majority of the direct health-care costs related to AS are incurred by hospitalizations, physiotherapy, informal care, and drugs. High disease activity and poor physical function are the most important factors associated with the total costs of AS. Cost-effectiveness analyses for different AS therapies have shown variable results. The use of different methodologic approaches to assess the cost-effectiveness ratios makes the findings of such analyses difficult to compare with each other. This article examines the effect of AS on work participation, costs of illness and reviews cost-effectiveness analyses of AS treatments.