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Research continues to try and breakthru what the actually causes are but it is known that it is mainly genetically acquired and hereditery by HLA-B27 gene. Not everyone with the gene with end up becoming active with the disease though. Environmental factors are also thought to be a factor and the immune system is a biggie. They believe if stress or trauma even perhaps a bacterial infection of some sort occurs it activates the disease and causes the inflammation and when this occurs the bodies immune system never really recovers. It is active. Not everyone person is the same either. What one person may have may be totally different from the next. So everyone can experience different signs and symptoms and progression.