Methotrexate is often prescribed along with a biologic in order to prevent/slow down the body's production of antibodies against the biologic. But in your case, you were already on MTX for the PsA, so your body's immune system really must've really crashed when you started Skyrizi. I was taken off of MTX years ago due to the number of infections I was getting, but also due to the fact that my rheumatologist felt my symptoms could be managed just as effectively with NSAIDs and occasional prednisone, and he was right, until a few years ago. In your shoes, I would speak to my doctors about starting me back on MTX, but at a lower dose. That, taken concurrently with Skyrizi should have some impact on your pain. My doctors work with me, and include me in the decision making process about my treatment plans. My rheumatologist will sometimes make suggestions, but he is also willing to listen to me, and go in the direction in which I feel we need to go in treatment. But, I'm also a special case, as I have always taken the time to study up on, and keep current on, this disease and the available treatment options.