In this educational segment, Wendy Simmons, PA-C, from Carolina Arthritis Associates in Wilmington, North Carolina, shares her nearly three decades of experience in rheumatology to address a critical question: What is the clinical significance of structural damage in psoriatic arthritis? Drawing on insights from decades of evolution in psoriatic arthritis care—from the pre-biologic era of the 1990s to today’s advanced targeted therapies—Wendy explains how persistent inflammation at enthesial sites can lead to periosteal reaction, joint space narrowing, and ultimately irreversible joint destruction. She reflects on early cases that demonstrated severe deformities underscoring the need for early detection and aggressive management to prevent disability and preserve quality of life. This discussion highlights why understanding structural progression is essential for optimizing outcomes in patients with inflammatory arthritis. For additional resources and in-depth data, visit the RhAPP website for expert-led rheumatology education tailored to advanced practice providers.