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We would like to thank Dr Feldtkeller1 for his remarks regarding our manuscript.1 We do agree that in ankylosing spondylitis onset is more accurately described by onset of symptoms as opposed to age at diagnosis. Unfortunately, we did not collect the time-of-symptom-onset data in three of the four studies in this analysis. Thus, we used the age at diagnosis as proxy for disease onset. In the ASCEND study (women n=147; men n=419) we reviewed the onset of symptom data that was similar between women (mean 13.0 years) and men (mean 13.4 years), which supports Dr Feldtkeller's statement, “the average age of disease onset (first symptoms of AS) does not differ significantly between male and female patients with AS”.2–4 In addition, the mean age of diagnosis in the …
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