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Bilateral avascular necrosis of both hips and both shoulders in a case with systemic lupus erythematosus: What should we blame, steroid or secondary antiphospholipid syndrome?
International Journal of Rheumatic Diseases, 03/14/07

Emad, Y., et al. - A 38-year-old female patient was diagnosed as a case of systemic lupus erythematosus (SLE) in 1994. Her initial presentation was nephritis which remitted on combination of steroid, azathioprine and pulse cyclophosphamide therapy. One year later the patient developed bilateral avascular necrosis (AVN) both hips and underwent bilateral hip replacement...It is suggested that in SLE patients with positive lupus anticoagulant and negative antiphospholipid antibodies, testing for reactivity against beta2 glycoprotein 1 is mandatory

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