I dont know what to do anymore...

In your situation I would consider seeking a combined
Dermatology-Rheumatology clinic at one of the major
university teaching hospitals. There are a dozen such programs operating nationwide.
Put all of your records in order and do some research
and make the calls. I hope you have access to good health coverage and are able to travel if needed.
Continue to advocate for yourself.
Have you been treated with biologic disease modifying
meds. Have you consulted an infectious disease physician??

God Bless You and praying for you right now.

Personally, I would try an Infectious Disease doctor and if you are not on a "mychart" website with the doctors who have diagnosed you, take copies of your diagnoses and bloodwork with you.

I'm so sorry you are going through so much. I believe there is hope for you. Blessings.....

@rbhegewald, I thought psoriatic arthritis was an autoimmune disorder. Doesn't that account for your symptoms? Are you on an immune suppressing medication that could cause the infections? So sorry you are suffering.

So sorry,wish I could help you.
I know exactly what you’re feeling.
I often feel defeated as you do at times.

@rbhegewald Welcome to Mayo Clinic Connect! You already see that members want to help and give you ideas of what has helped them. @seniormed has some very good suggestions. Pull all your information together and try to get an appointment at a comprehensive medical center or a university teaching hospital. Can someone drive you and sit in on your appointment? They are valuable for hearing all that you don’t hear and taking notes !
Do you mind telling us what state you’re in? When were you diagnosed with psoriatic arthritis?
Can you put everyone’s suggestions together and make a plan?

I know exactly how you feel, I do hope that you can find out what's wrong.
Have you tried pain medication? I know it's just a band aid but I don't know how I'd cope without it.
For several years now I have had all over body pain, all the time, plus truly debilitating fatigue. My whole life has changed.
My doctor has me on 750/350 Hydrocodone Acetaminophen four times a day.
This does help. (at 78 I am not concerned with the addiction aspect) I tolerate the medication pretty well but I would really like to know what is wrong with me. The only rheumatologist in my area diagnosed Willis–Ekbom Disease. (restless leg syndrome) I do not have restless legs.
My lab work and scans are both normal. Could this be fibromyalgia, and if so what sort of doctor should I see?

@lopus a rheumatologist diagnosed my fibromyalgia.

@rbhegewald
What types of doctors and tests have you seen/had so far? Who diagnosed you with PA and fibromyalgia and how did they (bloodwork, exam, etc.)? What were you prescribed for this? Is your pain in all joints, skin, muscle, back, head?

You may want to try to get 2nd or 3rd opinions and check to see what specialized bloodwork you have had/not had. It definitely sounds like you have systemic inflammation causing symptoms and pain. If your body is attacking itself, it can be exhausting.

Did you get the COVID vaccine? Were you tested for vitamin deficiencies/toxicities and a full thyroid and iron panel? Some bloodwork doesn’t go deep enough to the problem or shows “normal” within range but it may not be normal for you (you can compare levels today with levels in the past to see what was normal for you when you felt better). For example, I was “normal” on CBC for iron but a broad iron panel showed I was iron deficient which explained my exhaustion/brain fog to some degree. Also, I was told my thyroid function was “normal” but a full thyroid panel showed I had Hashimoto’s thyroiditis autoimmune system attacking my thyroid gland (showed TPO autoantibodies). They found a suspicious nodule in my thyroid lobe so it was surgically removed and then I became hypothyroid and needed to go on thyroid medication.

Have you considered an antidepressant or medication to help with pain like Cymbalta/duloxetine (helps with fibromyalgia/osteoarthritis/nerve pain/depression due to chronic pain). Chronic pain can cause depression and make pain levels increase due to changes in perceptions of pain.

@rbhegewald
P.S. Another thought is to see an immunologist to check allergies, a gastrointestinal doctor for celiac (endoscopy), and nutritionist/dietitian for diet changes to reduce inflammation.

Many of the folks on this forum are going through a similar situation. You are not alone. It looks like some great ideas have been posted but I want to add one. Do something every day that brings you joy. I know, maybe that makes you roll your eyes but it's vitally important. Not just self care, but sit down and think about something that you can go out in the world and do that you haven't done in a long time. Maybe it's because you're tired, or hurting, or too busy with other things...but put aside those excuses and make a plan to find something joyful to DO (not eat, or watch on tv, but DO). We deserve to be happy, and reconnecting to joyful moments gives us the strength to trudge through managing these complicated medical conditions. Maybe it's going out to a cafe with a good book, or going for a walk in a cute area, or just going for a leisurely drive somewhere beautiful. Find something joyful that's simple and just for you and make a plan to do it. Good luck friend, I hope it helps. Keep in touch, we all need each other.