Title: European multicentre study validates ELF test as biomarker of fibrosis in systemic sclerosis Giuseppina Abignano 1-3 , Jelena Blagojevic 1,2,4 , Lesley Anne Bissell 1,2 , Raluca B Dumitru 1,2 , Sookhoe Eng 1,2 , Yannick Allanore 5 , Jerome Avouac 5 , Silvia Bosello 6 , Christopher Denton 7 , Oliver Distler 8 , Gianfranco Ferraccioli 6 , Suzana Jordan 8 , Marco Matucci-Cerinic 4 , Voon Ong 7 , Michael Messenger 9 , Michelle Hutchinson 1-2 , Maya H Buch 1,2 , Paul Emery 1,2 , Francesco Del Galdo 1,2 1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; 2. NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom 3. Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy 4. Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy 5. Department of Rheumatology, University of Paris Descartes, Paris, France 6. Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy 7. Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom 8. Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland 9. NIHR Diagnostic Evidence Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom Funding: GA was funded by the “Fondazione Italiana per la Ricerca sull’Artrite (FIRA Onlus)”