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We aimed to identify whether distinct trajectories of damage accrual exist and to determine which variables are associated with different trajectory groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Incident cases of SSc (&lt;2\u2009years) were identified in the Australian Scleroderma Interest Group and Canadian Scleroderma Research Group prospective registries. Group\u2010based trajectory modeling was used to identify SCTC\u2010DI trajectories over the cohort's first 5 annual visits. Baseline variables associated with trajectory membership in a univariate analysis were examined in multivariable models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 410 patients were included. Three trajectory groups were identified: low (54.6%), medium (36.2%), and high (10.3%) damage. Patients with faster damage accrual had higher baseline SCTC\u2010DI scores. Older age (odds ratio [OR] 1.57 [95% confidence interval (95% CI) 1.18\u20132.10]), male sex (OR 2.55 [95% CI 1.10\u20135.88]), diffuse disease (OR 6.7 [95% CI 2.57\u201317.48]), tendon friction rubs (OR 5.4 [95% CI 1.86\u201315.66]), and elevated C\u2010reactive protein level (OR 1.98 [95% CI 1.49\u20132.63]) increased the odds of being in the high\u2010damage group versus the reference (low damage), whereas White ethnicity (OR 0.31 [95% CI 0.12\u20130.75]) and anticentromere antibodies (OR 0.24 [95% CI 0.07\u20130.77]) decreased the odds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We identified 3 trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. 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