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703 vs. 0.639). Structural equation modeling (SEM) revealed that NeP altered disease activity (β = 0.62, P 0.001), which influenced psychological status (β = 0.42, P 0.001). Of 63 patients who used etanercept for 3months, significant improvement was found in NP, TBP, and PP (all P 0.0001) but not in PDQ (10.60 ± 6.85 vs. 9.98 ± 6.40, P = 0.0671). Serum norepinephrine concentrations in patients with PDQ 19 were higher than those in patients with PDQ ≤ 19 and HC. We conclude that NeP contributes to pain in AS patients.