In the majority of patients with psoriatic arthritis (PsA), it is a chronic progressive disease, and only 12% of patients with early PsA will be in disease-modifying antirheumatic drug-free remission at 2 years. Radiologic damage occurs in the early stages of PsA; up to 47% of patients with PsA have radiologic erosions after 2 years. This article reviews the clinical features of early PsA, pathologic insights into PsA gleaned from studies of early PsA, and the current state of diagnostic imaging and therapeutics in early PsA.