A real-world “symptom-active / structure-stable” SpA/PsA overlap case across 5 years of serial X-rays + DXA—showing how a validator-governed, deterministic workflow can turn longitudinal imaging into reproducible, endpoint-relevant signals without exposing proprietary algorithms. When symptoms stay active for years, how do you prove “no new damage” — reproducibly, across timepoints and sites? This de-identified real-world case illustrates a high-friction phenotype in spondyloarthritis/psoriatic disease: persistent clinical activity with minimal structural drift over a five-year horizon. Despite multiple advanced-therapy exposures across distinct mechanisms (including IL-17A/F inhibition with bimekizumab) and recurrent symptomatic flares, serial radiography (2020–2025) shows no progression to radiographic sacroiliitis, syndesmophyte formation, or hip involvement. What this record contributes (beyond a typical case report): Endpoint relevance: a “discordance anchor” demonstrating why symptom-based endpoints can move while conventional radiographic structural endpoints remain flat—useful for mixed endpoint strategies and trial design. Cohort stratification: a concrete example of a low-progression, symptom-dominant subgroup that can reduce noise in registries, external/synthetic controls, and subgroup analyses. Cross-modal coherence: DXA (Nov 2025) is normal with high XR–DXA concordance, supporting a coherent “structure-stable” interpretation rather than measurement artifacts. What’s inside: Longitudinal, multi-region imaging spanning cervical/thoracic/lumbar spine + sacroiliac joints/pelvis + hips, with DXA correlation at the index timepoint (Nov 2025). A validator-governed, deterministic radiographic workflow emphasizing projection and completeness checks, producing reproducible longitudinal outputs with audit-ready lineage per timepoint (described at a high level; no proprietary implementation details disclosed). Research-facing composite stability descriptors presented at an implementation-opaque level (designed for harmonization without exposing internal algorithms). Collaboration note: Beyond the representative figures in this vignette, additional de-identified full-resolution images and structured summary tables may be available to qualified collaborators under controlled-access terms. Use and positioning: Educational/research communication only; not medical advice. No regulatory, diagnostic accuracy, or performance claims