OBJECTIVES:  To compare the disease status, treatments and outcomes of patients with AS receiving their first biologic in UK, Germany, France, Italy and Spain (5EU) with the US. METHODS:  A multi-country multi-center medical chart-review study of AS patients was conducted between October-December 2012 among physicians (rheumatologists: 5EU: 97%, US: 99%) in hospitals and private practices to collect de-identified data on AS patients who were recently treated with a biologic as part of usual care. Physicians were screened for duration of practice and patient volume and recruited from a large panel to be geographically representative in each country. Eligible AS patient charts (>2) were randomly selected from a sample of prospective patients visiting each center/practice during the screening period. Physicians abstracted patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status/outcomes. RESULTS:  Seven hundred and ninety seven eligible AS patient charts (5EU:613, US: 184) were abstracted; 701 (5EU:549, US: 152) patients were on their first biologic (mean-age: 5EU:42.5yrs/US:42.4yrs; female: 5EU:16.2%/US:17.1%). Time-to-1st biologic from diagnosis (5EU:55.3months/US:46.8months) and time-on-current biologic (5EU:31.7months/US:44.3months) differed between regions. Top-2 biologic treatments observed were – adalimumab (5EU:43%/US:35%) and etanercept (5EU:30%/US:41%). Among the top-3 reasons for biologic treatment initiation, ‘mechanism of action’ & ‘improve signs/symptoms’ were observed in both 5EU and US, whereas ‘positive personal experience’ (5EU) and ‘prevention of structural damage’ (US) were also observed. Key lab measures documented were: ESR (5EU:17.4mm/h, US:20.9mm/h) and CRP (5EU:8.8mg/dl, US:2.7mg/dl). Current disease severity per physician-judgment (mild:moderate:severe) was: 5EU-63%:32%:6%, US-62%:34%:5%. Among patients with available data, current HAQ (5EU:1.3, US:0.8), BASDAI (5EU:2.9, US:3.4), VAS provider score (5EU:2.9, US:2.5), VAS patient score (5EU:3.0, US:2.7), Swollen Joint Count (5EU:1.3, US:0.5), and Tender Joint Count (5EU:2.0, US:0.9) differed across regions. CONCLUSIONS: Among AS patients receiving their first biologic, disease severity differed between 5EU and US, with patients in 5EU with relatively higher burden and poorer outcomes.