Steroids are frequently used to treat moderate-to-severe lupus flares because they are highly effective and work quickly. However, steroids have many serious side effects, including potentially severe damage to joints or “osteonecrosis,” which is an interruption of the blood supply to the bone. The researchers hoped to learn whether starting steroids at a younger age is a risk factor for osteonecrosis. The results of this study suggest the possibility that steroids might contribute to a serious bone complication in some children with lupus.