Few topics in therapeutic radiology are more emotive than the use of systemic radiotherapy (RT) for non-neoplastic disease. Ankylosing spondylitis (AS) is such a disease that has been treated with systemic RT, both by external X-ray beams and by intravenous injection of 224Ra. These modalities appear out of favor in recent times. Muscoplat et al. ( 1 Muscoplat C.C. Caperton E.M. Dusenbery K.E. Radiation therapy for inflammatory arthritis. Int J Radiat Oncol Biol Phys. 2004; 60: 688-689 PubMed Scopus (3) Google Scholar ) presented the case of an AS patient treated with megavoltage RT who experienced immediate and lasting relief; these authors call for inclusion of RT in modern AS clinical trials, especially for recalcitrant spondyloarthropathies. Others have called for such AS trials ( 2 van der Linden S. van der Heijde D.M. Ankylosing spondylitis and other B27 related spondylarthropathies. Bailliers Clin Rheumatol. 1995; 9: 355-373 Abstract Full Text PDF PubMed Scopus (7) Google Scholar , 3 van den Heijde D. Braun J. McGonagle D. Siegel J. Treatment trials in ankylosis spondylitis: Current and future considerations. Ann Rheum Dis. 2002; 61: iii24-iii32 Crossref PubMed Scopus (59) Google Scholar ), in strict compliance with the U.S. Food and Drug Administration guidance issued for rheumatoid arthritis trials ( 4 United States Food and Drug Administration. Clinical development programs for drugs, devices, and biological products for the treatment of theumatiod arthritis. Available at http://www.fda.gov/cder/guidance/1208fnl.htm. Accessed 1 October 15, 2004. Google Scholar ). Inclusion of RT in such trials is well warranted, especially in light of the data from the two RT for AS data sets from Britain and Germany.