I take NSAIDs for psoriatic arthritis, but there are sudden changes in hand X-ray. Kindly help me.

Hi doctor,

I am a 40-year-old female with presumed psoriatic arthritis. At the onset, I had mild, intermittent finger swelling and pain over five years ago, also, intermittent SI joint pain. SI joint X-ray only mentions mild sclerosis. Recent hand X-rays show three small erosions in my fourth and fifth finger PIP joints. I have been following at a rheumatology clinic for over five years. My symptoms have always been rather mild, with rare flares that are controlled well with brief courses of NSAIDs. Lab tests in the past were normal. My rheumatologist is on the fence on whether I should go onto a DMARD given how mild my symptoms have been. We are only discussing it now due to the recent X-ray findings. Any insight or thoughts into the pros and cons of continuing with symptomatic NSAID as needed only or starting a DMARD due to minor X-ray changes? I take Ibuprofen or Aleve as needed, and multivitamins and Vitamin D. Kindly give your opinion.