Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis. Arthritis mutilans is a rare clinical form of PsA in which osteolysis and destructive changes in the joints lead to irreversible deformity and loss of function. This paper describes three patients with psoriatic arthritis mutilans who were followed for up to two years and received treatment with etanercept, a TNF-alpha targeting agent that is used to treat PsA and psoriasis. Although these patients experienced significant joint and skin improvement with etanercept therapy, they retained lasting deformities from years of progressive disease. In order to prevent permanent joint damage, early recognition and treatment of PsA are critical. This highlights an important role for dermatologists in identifying early joint symptoms that may be suggestive of PsA in patients with psoriasis.