OBJECTIVES Ankylosing spondylitis (AS), one of the most common spondyloarthritides, is a chronic condition with a significant impact on patient quality of life (QoL), particularly physical functioning. The objective of this research was to systematically review published data relating to the societal burden of AS. METHODS Embase, Medline, and Cochrane databases (accessed November 2013) were interrogated. Studies reporting on non-health sector costs or work disability associated with AS were eligible for inclusion. RESULTS In total, 42 studies met eligibility criteria; 19 studies reported indirect costs associated with AS and 23 studies reported AS-related work disability. Studies were conducted across Europe, Africa, North America, and Asia. All studies defined indirect costs as costs associated with productivity loss. Annual indirect costs, calculated using the human capital approach, ranged from €595 (Belgium) to €9,837 (Germany). Friction costs calculated ranged from €428 (France) to €6,843 (Spain). Considerable heterogeneity was reported, with 2-year indirect costs of €66,907 estimated in Norway. Despite heterogeneity between studies, 75% of publications reported indirect costs of less than €4,500 per patient/year, representing between 34% and 74% of total costs. Non-medical costs such as informal care, and transportation ranged from $65 (US) to $3,663 (US), indicating that loss of productivity was the main driver of indirect costs. Estimates of work disability varied greatly across studies primarily due to heterogeneous populations and the lack of standardised questionnaires. The work disability of AS was multifactorial with regression analyses identifying several factors associated with both indirect costs and disability including demographic factors, disease and job characteristics. CONCLUSIONS Although reported indirect costs and work disability estimates varied between studies, findings from this systematic review indicate that AS represents a substantial burden both on society and individuals with AS. A lack of UK-based data illustrates the challenge of incorporating societal costs into future UK reimbursement submissions.