OBJECTIVES: Tuft resorption (TR) is an important radiographic feature of psoriatic arthritis (PsA). We aimed to define the prevalence of TR in patients with PsA, the clinical and radiographic features associated with it, and the risk factors for its occurrence. METHODS: We included patients with PsA followed at our prospective observational cohort. We defined TR as resorptive changes in the terminal tufts of the fingers or toes. We used generalized estimating equations to characterize clinical and radiographic features cross-sectionally associated with TR. We used multivariate Cox regression analysis to identify factors associated with the development of TR. RESULTS: Of the 1303 patients included in the study, 526 (40.4 %) were observed to have TR, of whom 181 (34.4 %) developed it during follow-up. TR was associated with older age (OR 1.49, p <
0.01), longer duration of PsA (OR 1.03, p <
0.01), higher radiographic damaged joint count (OR 1.02, p = 0.04), axial disease (OR 1.73, p <
0.01), and the number of systemic disease-modifying anti-rheumatic drugs (DMARDs) used (OR 1.27, p <
0.01). Male sex (HR 1.54, p = 0.01), vertebral osteopenia (HR 1.39, p = 0.02), and use of non-steroidal anti-inflammatory drugs (HR 1.43, p = 0.03) were associated with the development of TR. Use of biologic and targeted synthetic DMARDs was protective (HR 0.70, p = 0.05), although not significant at the 5 % level. CONCLUSION: TR is a common radiographic feature of PsA. It is associated with more severe disease, including peripheral and axial radiographic damage.