I was scared to death of starting Methotrextrate, so much so, that I let my toes all swell up and become slightly deformed. The breaking point for me was when it started to affect my hands, one of my baby fingers is swollen and I can't bend it. I panicked that all my fingers were going to go that way, so I figured I had to do something and bite the bullet and started mtx.
For me it wasnt as bad as I thought it would be, I recently switch from pills to needles and I hate needles, but it isn't as bad sticking myself with a needle as I had thought.
My reason for not starting earlier was that I was scared to death about the side effects. But a Rhuemy recently said to me: 'You definitely have PsA and worrying about what you Might get with side effects is no reason to not treat what you do have 100%". That kinda hit home, so take one day at a time and try mtx, remember you can always stop at any time.
Hope that helps. I put it off for 2 years and now I have deformed fingers anf toes that I might not have had I started when I first discovered I had PsA.