People with psoriatic arthritis (PsA) often continue to experience significant pain even when they are receiving advanced treatments and their inflammation appears to be under control. This can be frustrating for patients and challenging for healthcare professionals, as pain is commonly used to assess disease activity and guide treatment decisions. In this study, we examined 380 people with PsA who were experiencing persistent pain despite receiving advanced therapies. We found that pain in PsA is not always caused by ongoing inflammation. Different pain mechanisms may be involved, including pain related to inflammation, pain linked to nerve dysfunction, and pain caused by changes in how the nervous system processes pain signals. These different types of pain were common and often overlapped in the same patient. We also found that patients with multiple pain mechanisms tended to have a greater disease burden, including more widespread joint involvement, higher rates of fibromyalgia, and higher disease activity scores. Our findings suggest that pain in PsA is more complex than previously thought. Understanding the underlying cause of a patient's pain may help clinicians interpret disease activity more accurately and make more informed treatment decisions. Ultimately, a more personalized approach to pain assessment could improve care and quality of life for people living with PsA.