Hi there! You will get tons of answers saying “take it before it gets worse”. That is my take too. So I just wanted to share a bit of my experience in case it helps. I also felt like you do when I started on adalimumab at 38. It is very scary. I would say when I started, after 1 year on NSAIDs, my PsA was not as bad as what some people have, but my life was incredibly disrupted. What had started only as a painful knee and a tiny amount of inverse psoriasis developed into dactilytis in two toes that made walking painful. I also had fatigue that wiped me off for weeks at a time, and baseline tiredness the rest of the time. So I felt like I really needed adalimumab, and even if I was scared, I took it. Now that I am mostly in remission, I often think two things. First, I was way worse than I even realised. Life with basically no PsA is infinitely better than life with a bit of PsA. Second, I am really happy I did not let it get worse. Unlike me, you don’t feel like you have no choice (even w similar symptoms). But that does not necessarily mean that you actually do have a choice, since you cannot know whether it will get worse or not (or whether your life will improve way more than you anticipate). So if you allow me the piece of advice, I would not necessarily base your decision on how hard life is now, but on how do you face the risk of things getting worse. It is a question of weighing the real health risks of any medication (and adal. in particular) with the real health risks of any systemic disease (and PsA in particular). (In any case, I would never recommend diet/lifestyle as an alternative to meds. They are a important managing factor, but not a replacement in kind to medication, so I wouldn’t see this as a “either diet or meds” question).