Hi there   I am so sorry that you are in so much pain.   Here is some information from the National Psoriasis Foundation:  "A portion of people who have three or more affected joints may have a higher risk of joint destruction and disability. When it is not relieved by anti-inflammatory drugs, more potent medications may be required. Some cases may require surgery and rehabilitation."   Here is more information from the Johns Hopkins Arthritis Center about possible treatments.   I am not sure what to tell you other than be assertive with your doctor and tell them that the current treatments are not working and to ask what your options are at this point.   I hope things get better for you and thank you for your question.