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Background Understanding the impact of psoriatic arthritis (PsA) on an individual and how the disease evolves over time is important when determining a therapeutic strategy. However, little is known about the natural course of arthritis, psoriasis, and enthesitis, their relative impact on quality of life and how disease burden in real world cohorts compares to clinical trial populations. We set out to describe the burden of disease and impact on quality of life in an observational UK secondary care cohort. Methods Cross sectional cohorts were selected from the Bath PsA cohort, group one with early disease (within 24 months of diagnosis), groups two and three with established disease (commencing therapy with first or second line biologic Disease Modifying Anti-Rheumatic Drug- bDMARD therapy respectively; assessments both at initiation and 3 months after initiation). Results Analyses were undertaken where sufficient data was available on 154 patients eligible for entry into the early PsA cohort (group 1), 240 patients eligible for the biologic initiator cohort (group 2) and 103 for the second line biologics initiator cohort. Cohort characteristics are reported in Table 1. The burden of joint disease was high in all cohorts and approximately comparable to clinical trial populations in group 2 commencing bDMARD (mean tender joints count 22 (SD 14), swollen 7 (SD 5) cDAPSA mean 36 (SD 15)). Mean Body Mass Index (BMI) rose from overweight in early disease to obese in established disease (table 1). There was little enthesitis in any group (LEI mean &amp;lt;1). There was a significant burden of joint disease (cDAPSA), fatigue (FACT) and work disability among those 3 months post commencing bDMARD despite good clinical responses (table 1). The level of skin (PASI) and nail disease (Bath Nail score) was low but remains strongly associated with worse quality of life and the association was stronger in established disease. Conclusion We report high levels of residual joint disease, fatigue, obesity and work disability in both early and established PsA cohorts. Despite low absolute levels of residual skin and nail disease both become more strongly associated with worse quality of life in more established disease. Disclosures W. Tillett: Honoraria; Eli Lilly, Janssen, Novartis, Pfizer, UCB. Grants/research support; Abbvie, Eli Lilly, Celgene. A. Rambojun: Grants/research support; EPSRC. A. Bradley: Shareholder/stock ownership; Eli Lilly and Company Limited. Other; Employee of Eli Lilly and Company Limited. J. Mount: Shareholder/stock ownership; Eli Lilly and Company Limited. Other; Employee of Eli Lilly and Company Limited. C. Cavill: Grants/research support; Eli Lilly and Company Limited. E. Korendowych: Honoraria; Abbvie, Eli Lilly, Janssen, Novartis. Grants/research support; Eli Lilly and Company Limited. N. McHugh: Consultancies; Abbvie. Grants/research support; Eli Lilly and Company Limited.

P264 Burden of disease and relative impact of skin and joint disease on quality of life in PsA: analysis from a UK secondary care cohort