<p>Psoriatic arthritis (PsA) is a systemic chronic inflammatory disease characterized by arthritis and structural damage of joints associated with persistent inflammation. Radiographic progression (RP) is typically used to measure the development of structural damage using different semiquantitative scoring methods. An important therapeutic goal is to prevent structural damage. Visualizing such damage using RP seems to predict shorter survival in patients with PsA. Therapeutic agents that inhibit structural damage are considered disease-modifying in PsA. There are no validated and clinically useful biomarkers for stratifying patients and informing clinical treatment decisions to increase the likelihood of a response to any given therapy. This narrative review examines current approaches for assessing the extent of structural damage in PsA, monitoring of PsA disease activity, risk factors that contribute to the progression of RP in PsA, and discusses the efficacy (inhibition of RP) of the new approved therapies that have emerged over the last few years for use in PsA. While there are unmet needs to clarify and define RP, the extent of structural damage in the peripheral forms of PsA was most frequently determined using the PsA-modified Sharp and Sharp-van der Heijde Rheumatoid Arthritis scoring methods. Factors that lead to a more aggressive, faster, or more active RP are also related to the number of activity indicators (overweight, smoking, etc.). In patients with high psoriatic activity and thus greater disease progression, determining structural damage at 6 months of follow-up may be sufficiently sensitive to obtain RP information and evaluate the evolution of the disease.</p>