<s>[INST] Hi Doc: Do you know much about Paso-Arthritis? I am 63, have had the disease since I was 21. Tried many natural (Dead Sea) and medical ( Methotrexate) before going on Otezla 2 and a half years ago. It was miraculous! I returned to Mountain Biking, Tennis and other sports. About 6 months ago lesions started RE-appearing. Then pain and stiffness. I need some relief other then Ibuprofen. I am scared to go on Biologics. Any suggestions? [/INST] Hi, Psoriasis arthritis affects Large joints. Joints disease worsens with skin lesions. Treatment is two-way:1. Treatment of skin lesions2. Treatment of joint disease.  Joint involvement usually decreases as skin lesions are controlled. Primary line of joint treatment is disease modifying agents Like Sulfasalazine and Methotrexate which you have taken. If they are not giving relief next line of treatment is biological agents. They are very effective to control disease visit to rheumatologist is recommended.  Hope I have answered your query. Let me know if I can assist you further. </s>