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Background: To date no clinical trials are available showing efficacy of mod-eratly dosed prednisolone for the therapy of active ankylosing spondylitis (AS). Objectives: To evaluate the efficacy and safety of moderately dosed pred-nisolone versus placebo over 2 weeks in patients with active AS despite NSAID treatment. Methods: Of 39 patients enrolled, 36 finished the trial. Patients were randomized to one of 3 groups. Prednisolone was given double blind as 20 mg (n=13), 50 mg (n=12) or Placebo (PBO) (n=14) orally every day over 2 weeks. Mean age of the patients was 41 years (range 19-72), mean disease duration was 14 years (range 1-55), HLA-B27 was positive in 71 % of patients. Clinical outcome assessments included disease activity (BASDAI), function (BASFI), metrology (BASMI), patient’s global assessment and pain (PG), peripheral joint assessment, Berlin enthesitis score, and C-reactive protein (CRP). Primary endpoint of this study was improvement of BASDAI 50 at Week 2. Results: Mean change of BASDAI was significantly higher in the 50 mg group, p=0.026, when compared to PBO whereas this was not the case for th