Aim: Sulphasalazine is used widely as a second-line treatment of ankylosing spondylitis (AS) after non-steroidal anti-inflammatory drugs (NSAIDs) in Finland. The objective of this study is to evaluate the use of disease-modifying anti-rheumatic drugs (DMARDs) and drug survival in incident AS patients at Helsinki University Central Hospital (HUCH). Method: We identified all incident patients with AS in the hospital register from 1 Jan 2005 to 31 Dec 2009. The index day was defined as the date of AS diagnosis. Medication and clinical data were evaluated until the end of 2010. Results: 176 patients were identified. For 165 of them a DMARD was started. In 9 patients with low disease activity the drug treatment consisted only of NSAIDs. Sulphasalazine was the first synthetic DMARD for 157 (95%) patients. No one were prescribed a biologic drug as the first DMARD. The mean follow-up time was 3.8 years. The mean synthetic DMARD survival was 80%. Bath AS Disease Activity Index (BASDAI) available from 46 patients was 4.1 (1.8) at baseline and decreased by 1.6 (95% CI 2.2-1.1, p<0.001) during the DMARD treatment. Because of continuing disease activity, 28 (17%) patients became eligible for reimbursement of biological DMARDs and a TNF inhibitor was instituted. This was predicted by peripheral disease, higher ESR, and CRP at the baseline. Conclusion: Most patients with incident AS do fairly well with synthetic DMARDs but the proportion of the patients needing biological DMARD treatment grows over time. Use of synthetic DMARDs may reduce or postpone the need for biological DMARD treatment in AS.