Hi Ken!

Boy, that is a big question, and one I don't think anyone can answer with certainty. There is still a lot that is not known about this disease, but there are a lot of theories out there. However, it is important to remember that they are only theories and remain unproven by research at this time.

There appears to be a genetic link. HLA-B27 is one gene involved, but probably not the only gene. There is some thought that HLA-B27 acts in concert with other genes to predispose one to get AS, but not everyone with this gene gets AS, and some people with AS do not have HLA-B27. It would appear that it takes some genetic combination plus a trigger to start the disease going. Maybe it is some other gene that really causes it, and HLA-B27 is the trigger gene. Who knows? I don't, and unfortunately medicine cannot yet provide these answers. Because AS is rare, it has not received the research attention and dollars that other illnesses have such as Rheumatoid Arthritis or Lupus. The trigger could be injury, or some viral or bacterial infection. The truth is there appears to be a connection, a lot of anecdotal evidence, but not a lot of empirical evidence obtained through research yet. Some people believe it is connected to diet. I don't want to knock those who swear by the no starch diet, but I have tried that and during that period my AS was at its worst. If you want more information on that, there is a NSD forum here to find more information.

In my own case, I had mild symptoms going back to my teens, but nothing serious enough to cause me a lot of pain or really slow me down. After a slip and fall on ice where I twisted my knee and tore ligaments, my AS jumped into high gear and I had a very bad four years. It would make sense to me that stress, which can be caused by injury, would be related since stress directly impacts on the immune system, and this is an autoimmune disease.

I'd like to see what others think and I will follow this link with interest.

Welcome! I look forward to your future posts.

Val.