A trip to Canada May be worth it where a rheumatologist can prescribe you an effective biologic. Follow-up visits could be via Zoom. Biologics, in my experience, have been far more effective than methotrexate ever was.

Hi Keith & Joanne.
We all are on Methotrixate. Starts with 10mg to begin. Day before take Folic acid 5mg. Specialist may double later.
I have no idea the symptoms of "damage" look like. I can't see myself in a wheelchair or not walking as result of permanent damage.
To me its living with the symptoms, pain & effects of daily life. Tops of my feet, toes, ankles continually inflamed. I have other diagnosis similar family as PsA (not RA). It's all a blurry line for me where one ends and anotherbegins. Tendons are my thing. I have had surgery- both my thumb tendon had tendon sheith cut due to chronic inflammation. Still inflamed but not rubbing sheith. One shoulder surgery tendon tears & off bone. There will be more to come.

Keep reading & trust your gut regarding pain / symptoms / things you don't do until you can see the specialist. I don't think 3 months will result in permanent disability.

Hi Keith,
I had to wait 3 months for my first appt, was very disappointing! I was in alotof pain too. I asked the question you mentioned about permanent damage, was like it wasn't even acknowledged, talk about infuriating!