@jw9 Hi there, thank you for your message. My RA was initially diagnosed at age 52 (69 now) following getting Lyme disease and acute adult B-19 parvovirus at the same time. However, I had already been dx'd with systemic lupus when I was much younger and was treated with plaquenil and nsaids for years, and I had a positive rheumatoid factor as young as age 16. That was when I first developed uveitis and lupus. My rheumatologist, who dx'd the RA said my labs were positive as we're my films of my hands. This was pretty cut and dry so I began Enbrel right away, stayed on plaquenil and skipped methotrexate as I had been a wine drinker. So, for 8 years Enbrel worked and then I began flaring more often. My rheumy retired, I found another and went from one biologic to another. Nothing worked long term. I got fed up and switched docs again a couple of years back. She agreed that I clearly had worsening RA and we moved into Rinvoq which helped more than the others, but I had constant infections and other side effects. Meanwhile, my fingers, wrists,elbows and feet were really beginning to look much worse and I began have a lot more back pain. My nails had vertical groves and lots of black needle like marks and the first joints were noticeably bigger. That was when she began thinking of a PsA overlap. I do not have skin rashes other than JAKne which is sort of similar to acne, but not really the same (no pus in pimples), so anyway, long story- she's changed my dx to RA with PsA overlap. Skin symptoms sometimes never show up. Who knew? Sometimes, they eventually will. I can promise you that back when I was 16, a lifeguard who developed uveitis and lupus, I never dreamed that one person could get slammed with five damn autoimmune diseases. It's taken years to develop all this, but it's definitely happened to me. I'm grateful not to have the itchy rashes on top of everything else. I really do get where your coming from. It's all bad. But my rheumatologist assures me that they do see this overlap thing and it's fairly well accepted now that some folks get multiple separate autoimmune diseases over the span of years. My doctor has added Leflunomide to my current Xeljanz to give me better coverage with the PsA. It's got to work soon I think because I have really gone downhill pretty quickly. But whatever happens, I have learned to accept things I really can't control. I'm fair skinned, blue eyed, all Irish genes, just didn't get a lot of luck with my health. So, I have beautiful kids and grandkids to focus on. That's good enough. Good luck to you. I hope your doctor can find a drug regimen that works for you. I get acupuncture in my feet and Chinese massage in my legs and back. It does help somewhat, but Medicare doesn't cover that. I hope this long story helps clarify things.- robin