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Background: Among patients in the United States with psoriasis (PsO), limited data exist on the incidence and prevalence of psoriatic arthritis (PsA) based on disease severity., Objective: To assess the incidence, prevalence, and predictors of PsA among patients with PsO stratified by PsO severity using treatment type., Methods: Incidence of PsA per 100 PsO patient-years (PY) and prevalence were assessed using the Optum electronic health records database. Incidence was assessed from PsO diagnosis and 1 year after PsO diagnosis overall and stratified by mutually exclusive treatment classes as a severity surrogate., Results: The overall incidence of PsA was 2.9 (95% CI, 2.9-3.0) events per 100 PY. The incidence (95% CI) by severity surrogate was 2.1 (2.1-2.1), 9.9 (9.5-10.4), and 17.6 (16.9-18.3) events per 100 PY for patients with mild, moderate, and severe PsO as determined by receiving nonsystemics, nonbiologic systemic therapy, and biologics, respectively. When excluding patients diagnosed with PsA 1 year after PsO diagnosis, overall incidence was lower (1.7 [95% CI, 1.6-1.7] events per 100 PY), with similar trends for treatment-severity surrogates., Limitations: Results may not be generalizable to a wider population., Conclusion: The risk of developing PsA increased with disease severity and was highest in patients with the most severe PsO., Competing Interests: Conflicts of interest Dr Merola is a consultant and/or investigator for Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharmaceuticals, Biogen, Pfizer, EMD Serono, Avotres, and LEO Pharma. Dr Tian and Author Patil are employees of Novartis Pharmaceuticals Corporation. Dr Hur was an employee of Novartis Pharmaceuticals Corporation at the time of this study. Author Richardson is an employee of Novartis Pharma AG. Author Scott was an employee of KMK Consulting, Inc, providing services to Novartis at the time of this study. Author Chen is an employee of KMK Consulting, Inc. Dr Kim was a postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation at the time of this study. Dr Armstrong has served as an investigator or consultant for AbbVie, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, EPI Health, Janssen, LEO Pharma, Modernizing Medicine, Novartis, Ortho Dermatologics, Regeneron, Sanofi Genzyme, Science 37, and UCB., (Copyright © 2021. Published by Elsevier Inc.)