psr: Can you take a 6 day methylprednisone taper? that might just knock this out for you.
I was dx'ed in sept 2010. I started humira in june 2013. In between those dates, I took methylpred for my flares. But I was needing it too often (every 10-13 weeks) and too, with diabetes, it raises my blood glucose. So now its good being on the Humira for me.
But since you are off the Humira, maybe try a short course of steroids.
One time when I needed the steroids for a flare, a 6-10 day course of methylpred knocked out a stubborn TMJ that I had had for months that the dentist and I had been trying to resolve in more traditional dental ways, but the steroids knocked it out and it never came back, then I started Humira and its never been back since.
I also had a really good podiatrist; I haven't needed her in years now since Humira. But she was able to help me with my feet in ways no other of my doctors could. I've had terrible foot problems over the years.
I can say ice or contrast baths helped my feet in the past more than most anything else.
Too, ultrasound, has been very helpful for me. I'm not exactly sure how or why it works, but it does. They say its deep heat, but I think there is more to it than that. I used to get it done at PT, then a chiro office, now I have a home unit, and there are times its very helpful still.
and I hear you with scans showing nothing dramatic, but still there being a huge problem. That's the way it is with this enthesitis stuff. I "injured" my ulnar wrists very badly, to the point of needing a cortisone injection in one once and couldn't use that hand for 2-3 years, and yet the MRI showed very little if anything. I've read that there is a ligament in there that can unravel and only be seen with exploratory surgery, not any kind of imaging will pick it up. Last fall I needed to go back to specialists for the other ulnar wrist and I was told that the cartilage in there can get inflamed.
its complicated, but things like ice, ultrasound, steroids, PT can fix or at least settle down the problem even when the problem can't exactly be pinpointed.
and time...sometimes time is the only real thing that works...but those other things can shorten the time.
Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
no dairy (casein sensitivity), limited eggs, limited yeast (bread)