Background Clinical research is receiving an increasing amount of attention and is essential for improving treatment of patients with rheumatic diseases. Aims This article reports on 15 years of experience with conducting investigator-initiated studies on axial spondyloarthritis including ankylosing spondylitis. Results We have organized and successfully conducted a series of open-labelled and placebo-controlled double-blind treatment studies and also non-interventional studies on this topic. The installation of a qualified and motivated trial unit and intensive collaboration with a statistician were crucial requirements for success. These results have increased our knowledge about the disease and changed and improved the diagnostic possibilities and the therapeutic options. Conclusion Investigator-initiated trials are an important link between basic and clinical research and can substantially contribute to improvement of patient care. This kind of research should be more systematically funded in the future.