Aim: To evaluate the role of musculoskeletal ultrasound (MSUS) in the diagnosis and management of psoriatic arthritis (PsA), focusing on its utility in detecting inflammation, monitoring disease activity, and influencing therapeutic decisions.Material and Methods: A prospective, observational study was conducted involving 120 PsA patients diagnosed using the CASPAR criteria. All participants underwent a comprehensive clinical evaluation, including DAS28-CRP, Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), and patient-reported outcomes such as VAS Pain and Global Health. High-resolution MSUS assessed 40 joints and entheses for synovial hypertrophy, effusion, power Doppler signals, enthesitis, enthesophytes, and calcifications. Findings were correlated with clinical and laboratory measures, and their impact on therapeutic decisions was analyzed.Results: The mean age of participants was 45.6 years, with 60% males. MSUS detected synovial hypertrophy in 81.67%, joint effusion in 74.17%, and power Doppler positivity in 53.33% of patients. Enthesitis was identified in 56.67%, with structural damage observed as enthesophytes (45.83%) and calcifications (28.33%). Subclinical inflammation was noted in 20% of cases for synovial involvement and 15.83% for enthesitis. MSUS findings led to medication adjustments in 35% of cases, initiation of biologics in 15%, and DMARD changes in 20%. Significant correlations were observed between MSUS findings and DAS28-CRP (r = 0.62) and LEI (r = 0.58).Conclusion: MSUS is a valuable tool for diagnosing and managing PsA, offering superior sensitivity in detecting subclinical inflammation and structural damage. Its integration into routine practice enhances diagnostic accuracy, facilitates early interventions, and supports personalized treatment strategies, improving patient outcomes.