Dr. Fallahi objects to our statement “none of these physical examination techniques, including spine mobility measurements, reliably distinguish inflammatory diseases of the spine, such as axial spondyloarthritis, from common degenerative diseases of the spine” and then provides no explanation, or the reason, to their objection. We think history and physical examination is an important and vital aspect of clinical medicine in general, and diagnosis and management of axial spondyloarthritis in particular. Having said that, we still maintain that there is no part of the spinal examination that is specific enough to differentiate “inflammatory” from “mechanical” spinal involvement. Dr. Fallahi’s letter repeats the list of causes of delayed diagnosis that we have already discussed at length in our manuscript.