A 47-year-old male presented to our rheumatology clinic with complaints of exaggerated thoracic kyphosis and limited range of back motion. In his early 20s, he visited a rheumatology clinic because of hip pain and lower back stiffness and was diagnosed to have ankylosing spondylitis. Plain radiographs identified grade II sacroiliitis and elevated C-reactive protein levels and human leukocyte antigen B27 positivity were also detected. At that time, he was prescribed anti-inflammatory drugs but he refused to take the medicine as he experienced gastrointestinal disturbance and eventually lost to follow-up. Upon his initial presentation to our clinic, radiography revealed numerous gold threads around his sacroiliac (SI) joints (Fig. 1), and it was speculated that the patient had experienced serious SI joint pain. In our clinic, we performed the screening and prophylaxis prior to initiating anti-tumor necrosis factor (TNF)-α treatment and prescribed the anti-TNF inhibitor. The patient reported a substantial diminishment in pain and is currently on a regular follow-up schedule.