OBJECTIVES: To describe the diagnosis and treatment pathway of patients with AS. METHODS: Rheumatologists from 18 countries, including Brazil and Mexico (LatAm), and their AS patients were surveyed. Rheumatologists provided information on patients demographics, disease and treatment history; patients voluntarily provided demographics and disease history. RESULTS: 641 Rheumatologists (LatAm: 31) included 2,887 patients (LatAm: 139). On average AS diagnosis occurred 3.0 years (SD:5.5) after symptom onset (LatAm: 2.8years; SD: 5.8). After this long period without specific AS treatment, at diagnosis only 71.7% received conventional therapy (Non-Steroidal Anti-Inflammatory Drug with or without conventional systemic Disease Modifying Anti Rheumatic Drug (csDMARD)); 9.0% received biologic therapy, 19.3% were not started on any pharmaceutical treatment included the ASAS AS recommendations despite being symptomatic (LatAm: 66.2%, 9.4%, 24.5% respectively). These patients without treatment initiation at diagnosis (n=531; LatAm: 36) waited on average an additional 4.1years (LatAm: 3.7years) before their first pharmaceutical treatment was initiated. Almost half the patients received csDMARDs (45.7% LatAm: 57.6%), of whom 42.9% (LatAm: 20%) had purely axial disease where there is a known lack of efficacy of csDMARDs . Of patients currently receiving a biologic, almost half (46.4% LatAm:55.6%) received at least 1 csDMARD before the biologic, 27.1% 1 csDMARD; 15.6% 2 csDMARDS; 3.7% >3 csDMARDs (LatAm: 32.3%, 19.4% 4.0% respectively). Patients who receive >1 csDMARD before biologic waited longer before biologic therapy was initiated (3.3 vs. 2.4 years, p=0.0001; LatAm: 2.2 vs. 1.1 years, p=0.0007). CONCLUSIONS: The analysis suggests there are opportunities to greatly improve AS treatment patterns: 1) by reducing the years that AS patients have to wait until confirmed diagnosis; 2) ensuring all patients receive effective treatment for AS immediately at the point of diagnosis; 3) by carefully assessing the use of csDMARDs in axial disease which seem to delay more effective biologic therapy initiation.