Results. The 326 patients (74% men) had a mean ؎ SD age of 55.0 ؎ 10.7 years, a mean duration of AS symptoms of 31.7 ؎ 10.2 years, and a mean BASFI score of 40.7 ؎ 25.6. BASFI scores increased with higher lifetime occupational physical activity (r ؍ 0.31; P < 0.0001), the number of comorbid conditions (r ؍ 0.25; P < 0.0001), and the duration of AS (r ؍ 0.12; P ؍ 0.04). BASFI scores were higher among current smokers compared with former/nonsmokers (55.5 versus 38.9; P ؍ 0.0002), and among nonwhites compared with whites (49.9 versus 39.3; P ؍ 0.02). In multivariable analyses, lifetime occupational physical activity, current smoking, education level, number of comorbid conditions, and family history were significantly associated with BASFI scores. The same risk factors were associated with the HAQS. Conclusion. Functional limitations in patients with AS for >20 years are greater among those with a history of more physically demanding jobs, more comorbid conditions, and among smokers, and are less severe among those with higher levels of education and a family history of AS.