This study looked at people with psoriatic arthritis (PsA) who are difficult to treat. These patients were more likely to have a higher body weight, Crohn’s disease, other types of psoriasis, and more inflammation in their blood. They also had a genetic marker (HLA-B27) more often. Compared to others, they needed more advanced medications from multiple drug classes, including biologics and JAK inhibitors. Nearly half tried four or more treatments. These findings suggest that difficult-to-treat PsA patients have more complex health needs and require more intensive therapy.