My mum has been battling
psoriatic arthritis for many years. Started in her big toe, and it now involves feet, knees, hips, and vertebrae in neck. She very nearly needed knee replacements on both sides, and was an big opioid user. Nothing controlled her pain, despite sulfasalazine, methotrexate, plaquenil, and heavy doses of oxycontin for pain, and a lot of illegal (bad for the liver...methotrexate is bad enough on the poor organ) tylenol.