Methotrexate (MTX) remains one of our most used and reliable tools against a variety of rheumatic diseases, including PsA. When the time comes, as it often does, to escalate from a MTX-monotherapy approach, we have several options. In clinic, initiation of these other medications has often been in the form of addition rather than substitution. But what do the patients want, and how much more is the MTX adding in those cases?