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7, 95% CI 2.57 - 17.48), tendon friction rubs (OR 5.4, 95% CI 1.86 - 15.66), and elevated CRP (OR 1.98, 95% CI 1.49 - 2.63) increased the odds of being in the high damage group versus the reference (low damage), whereas Caucasian ethnicity (OR 0.31, 95% CI 0.12 - 0.75) and anti-centromere antibodies (OR 0.24, 95% CI 0.07 - 0.77) decreased them. We identified three trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. These findings may be helpful i