For me, my PA was made worse by taking anti-inflammatories (e.g., ibuprofen, NSAIDS, methotrexate, etc.) They would work, but when they started to wear off and it was time for another dose, the inflammation was debilitating. It got to point where I had to take the medication right before bed and get up early before it wore off, otherwise it was a struggle to get up in the morning to take more medication. Well, I worked with my doctor and got off the medications and started making time for light exercise (e.g., going for a walk) everyday. I also looked for ways to reduce stress and not sit at a computer all day. I also started applying nail conditioner to fingernails and toenails because I also have the nail issue with psoriasis. I started doing these things about 15 years ago. I’m still dealing with the psoriasis, but the PA doesn’t give me much trouble these days. If I do have a bit of a flare up, I try to think back a couple days and figure out what may have triggered the flare up and try to adjust my routines to avoid the triggers. The biggest part for me was actually getting off the anti-inflammatories. I know it won’t work for everyone, and you should consult your doctor before altering your medication plan, but it did work for me.