The promise of imaging in psoriatic arthritis

Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease with variable involvement of peripheral joints, entheses, tendons, soft tissues, and the axial skeleton. While clinical assessment remains central to PsA care, it may be limited in establishing an accurate diagnosis, distinguishing inflammatory disease from common mimics, and fully characterizing disease activity over time. Musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) provide complementary, noninvasive methods for visualizing inflammatory and structural pathology across these tissue domains. This review summarizes current evidence supporting the use of MSUS and MRI in the diagnosis and management of PsA, with emphasis on clinically relevant applications, and briefly discusses emerging molecular and advanced imaging techniques. We discuss the role of MSUS in early disease detection, differential diagnosis, evaluation of dactylitis and enthesitis, assessment of disease activity and remission, and guidance of treatment decisions in routine practice, and review the role of MRI with a focus on the evaluation of axial involvement and deep inflammatory and structural changes not accessible by ultrasound. Practical considerations, including scanning protocols, contextual factors affecting interpretation, and emerging scoring systems, are highlighted. When integrated with clinical assessment, these imaging modalities improve diagnostic confidence and support longitudinal disease monitoring. Continued advances in imaging methodology and standardization are expected to further refine their role in the care of patients with psoriatic disease.