Psoriatic arthritis has been demonstrated to be a severe form of arthritis in a proportion of patients. Progression of joint damage has been noted even within the first 2 years of disease in almost half the patients. Polyarticular presentation, disease activity, and damage predict progression of joint damage. An increased mortality was reported from large studies of 428 and 680 patients with psoriatic arthritis. Cardiovascular-related disease is the most common cause of death, followed by respiratory diseases, cancer, and injuries and poisoning. Deaths from respiratory disease, cardiovascular disease, and injuries and poisoning were found to be higher than those in the general population. Predictors for mortality include a high sedimentation rate and radiological damage at presentation. Since disease activity is associated with progression of damage, and damage predicts mortality, it is important to treat patients aggressively to prevent these outcomes.