The Role of Musculoskeletal Ultrasound in Psoriatic Arthritis: From Preclinical Detection to Treatment Monitoring

PURPOSE OF REVIEW: Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory disease with highly heterogeneous clinical manifestations associated with psoriasis (PsO). The wide variability in presentation, together with the absence of definitive serological biomarkers, makes early diagnosis particularly challenging. This review evaluates the role of ultrasound in identifying and characterising musculoskeletal involvement across the psoriatic disease (PsD) continuum-from asymptomatic PsO to established PsA. RECENT FINDINGS: Ultrasound can detect subclinical synovitis, enthesitis, peritendonitis, tenosynovitis, bursitis, and structural damage in PsD. Evidence highlights its value in the early identification of musculoskeletal changes in patients with PsO who are at risk of progressing to PsA, with important implications for disease interception and prevention. Additional applications include differential diagnosis; assessment of enthesitis and distinction between inflammatory and non-inflammatory disease; and monitoring of therapeutic response, including in refractory disease. Ultrasound also demonstrates prognostic utility by detecting subclinical inflammation, predicting flares and future structural damage, and supporting personalized treatment strategies. Standardized ultrasound scoring systems and emerging methods for evaluating small hand entheses and dactylitis are also discussed. Ultrasound is an important tool for early detection, prognostic assessment, and management guidance in PsA, offering potential to prevent disease progression and inform precision medicine approach.