The term spondyloarthritis (SpA) is now increasingly used to classify and diagnose patients who are characterized by inflammation in the axial skeleton and peripheral manifestations (arthritis and enthesitis). The management of SpA should be tailored according to the current manifestations of the disease, the disease activity and functional impairment. The current article focuses on diagnosis and therapy in patients with axial SpA. Diagnostic procedures are discussed in light of diagnostic utility and feasibility in daily routine care. Cornerstones of treatment in patients with axial SpA are a combination of regular exercise and pharmacological treatment options aiming at anti-inflammatory strategies.