Inclusion Criteria:

• 1. 18 years old or older;
• 2. Both male \& female;
• 3. Psoriasis diagnosis (per dermatologist) for at least 2 years (in at least 30% of participants);
• 4. Willing and able to provide informed consent;
• 5. Fulfillment of HR-PsO criteria (Psoriasis (PsO) patients will meet the definition of HR if they fulfill the following criteria: a) PsO duration \>2 years and Psoriasis Body Surface Area (BSA) \>3% and positive imaging findings in MSKPDUS defined as a RM-PsASon score of \>3.36

Exclusion Criteria:

• 1. Evidence of inflammatory joint pain, enthesitis and/or dactylitis on exam;
• 2. Current systemic immunosuppressive medication use (i.e., methotrexate, apremilast) at the time of enrollment or biologic therapy (ever);
• 3. RA seropositivity (mid-high RF/ACPA titers);
• 4. Current active malignancy;
• 5. History of symptomatic polyarticular OA or other joint conditions (such as RA, gout, etc) that may impair the ability to assess for PsA development
• 6. Conditions where initiation of guselkumab is prohibited in the prescribing information, including clinically important active infection and untreated latent tuberculosis;
• 7. Known hypersensitivity to the study agent.