Objective To assess the clinical efficacy of adalimumab in ankylosing spondylitis (AS) through a comparative analysis of patient-reported outcome (PRO) measures.Methods We conducted a retrospective study of 158 AS patients treated at the First Affiliated Hospital of Anhui University of Science and Technology from January 2020 to December 2023. Based on treatment, patients were allocated to adalimumab group (n=61, 38.6%) or control group receiving conventional DMARDs and/or NSAIDs (n=97, 61.4%). Using propensity score matching (PSM), 37 well-matched patients were selected from each group for analysis. PROs, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analogue Scale (VAS) for pain, and Bath Ankylosing Spondylitis Functional Index (BASFI), were evaluated at weeks 8 and 16. Results After PSM, the adalimumab group demonstrated significantly greater improvements in PRO scores than the control group. Specifically, BASDAI and VAS scores were significantly lower in the adalimumab group at both week 8 and week 16 (all P＜0.05). While the BASFI scores were comparable at week 8 (P＞0.05), a significant improvement was observed in the adalimumab group at week 16 (P＜0.05). In the subgroup of patients with high disease activity (BASDAI≥4) at baseline, adalimumab treatment led to significantly greater reductions in BASDAI at both follow-ups compared to the control group (P＜0.05). Correlation analysis revealed that BASDAI, VAS, and BASFI scores were strongly interrelated in the adalimumab group at weeks 8 and 16 (all P＜0.001), a pattern not observed in the control group. Conclusion Adalimumab is superior to conventional DMARDs and/or NSAIDs in improving a spectrum of patient-reported outcomes, including disease activity, pain, and physical function, in patients with ankylosing spondylitis