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Introduction To date, no comparative multi-modal imaging data exist for pre-SSc patients, versus healthy controls (HC).Material and Methods Non-selected pre-SSc patients (n=20) fulfilling LeRoy’s criteria 1 (RP plus SSc-specific antibodies, RP plus scleroderma pattern, or RP plus both) of the Ghent University (hospital) Raynaud’s clinic and age-, sex-, and BMI-matched HC (n=20) were evaluated (1:1 matching). Dermal thickness (DT) was measured using high-frequency ultrasound (HFUS, 18MHz) at 17 sites.2 Nailfold videocapillaroscopy (NVC ×200 magnification) was evaluated qualitatively and quantitatively using standardized Scleroderma Clinical Trial Consortium (SCTC)/ European Alliance of Associations for Rheumatology (EULAR) Study Group on Microcirculation in Rheumatic Diseases consensus. Peripheral blood perfusion (PBP) was assessed by laser speckle contrast analysis (LASCA) as described previously.3 Group differences were analysed using generalised linear mixed models, with group, location and their interaction as fixed effects, while accounting for matching and within-subject clustering.Results Pre-SSc patients showed no evidence of SSc-related severe organ involvement 4 (table 1). While oesophageal symptoms were noted in 30%, there was no oesophageal dilation on HRCT. HFUS showed an effect of group on mean DT (likelihood ratio test p = 0.011). Significant locations included the right and left fingers (0.80 ± 0.04 vs 0.68 ± 0.04 mm, p = 0.012; 0.81 ± 0.04 vs 0.67 ± 0.04 mm, p = 0.015) and the left forearm (1.02 ± 0.05 vs 0.88 ± 0.05 mm, p = 0.035) (figure 1A). LASCA demonstrated reduced PBP in (volar) fingers in the Pre-SSc group (139 ± 12 vs 200 ± 12 perfusion units; mean difference = 61, 95% CI: 38-85; p < 0.001) (figure 1B). NVC in the pre-SSc group showed lower capillary density (7.8 vs 9.8/mm, p<0.001), increased microhaemorrhages (18% vs 7.4%, p = 0.032), and exclusivity of giant capillaries and scleroderma pattern (figure 2).Conclusions In pre-SSc patients, dermal thickness, functional and structural microvascular abnormalities are detectable before clinical skin or severe organ involvement. Future multicentric longitudinal studies are required to confirm multimodal differentiative value.References LeRoy, et al. J Rheumatol. 2001.Cutolo, et al. Clin Exp Rheumatol. 2025.Willems, et al. Diagnostics. 2023.Vanhaecke, et al. Rheumatology (Oxford). 2022.Abstract OC.13 Table 1Baseline characteristics of the study populationAbstract OC.13 Figure 1HFUS and LASCA findings in Pre-SSc patients and healthy controlsAbstract OC.13 Figure 2NVC findings in pre-SSc patients and healthy controls