For me, about 35 years, I reckon. Started having symptoms in young teens, wasn't dx'd until 23 yrs ago, though. Yeah, I know that the biologics can be crazy. I am not sure what decision I would make if it comes to that. I do know that I can not and will not do pred again (or any other steroid). My primary doc (who I have appointed my team leader of physicians) has straight up told my rheumy that I am NOT to have any steroids. Mental health is health, too.
Just cuz a rheumy is "the best" doesn't mean s/he is actually the best. The first one I went to un-dx'd me, and she was the best in cinci area. She went only by bloodwork, which is a big no-no. Not to mention that that was the -only- time in my history that I was seronegative. I almost drove off a bridge that day. I'm glad I didn't, because, come to find out, I had gone into remission, my body just didn't feel it yet. Was in remission for 8 yrs, and it just struck again a little over a year ago. I decided to go aggressive this time.
Was also thinking a box mod or something wider, but worried about the weight. It would be nice to have a local shop where I could just pick it up and feel the weight. I chainvape pretty constantly, at least right now in the beginning, so that's kind of important. Not to mention that I have had problems in the past smoking analogs! I smoke left-handed, and it would send those zappy pains down my hands and I would have to use my compression gloves. This was during flares, which have mostly stopped with the MTX.