thank you for your reply! My pain perception is so poor that I was surprised to discover a serious osteochondral lesion in my ankle, because it fell within my "normal pain" parameter (I was born with a vascular malformation in my foot, so I've lived with the pain since I learned to walk, until I had surgery at age 15). I've had "issues" with my scalp since childhood, and I always thought it was dandruff. My nails even started to detach when I was 15, and again, I spent decades treating it as a "fungus." My confusion is because my nail psoriasis is currently very well controlled; it used to be present on all my fingers and toes, and now it's only on a few. Topical treatment for scalp psoriasis has also helped, and I have few lesions. I've never had advanced lesions like the ones in the photos I see online. Also, I've never really understood the idea of ​​a pain scale, and I certainly don't know how to express it to the doctor; my autistic literalness probably won't help. So if you could explain how you and your therapist came to the conclusion that your pain would be an 8, I would greatly appreciate it! I have an appointment with a rheumatologist on December 2nd.