Osteonecrosis, also called avascular necrosis, is the result of multiple causes of bone tissue destruction, manifested as osteoarticular pain, bone destruction and loss of function, which seriously affects the quality of life of patients. Avascular necrosisis significantly related with systemic lupus erythematosus .Though pain is a common complaint, affected individuals can be asymptomatic. By the time children exhibit osteonecrosis, their condition has typically proceeded to the point where more invasive surgical intervention, such as total joint arthroplasty, may be necessary. So the screening protocols that could identify patients at greatest risk of avascular necrosis should be made to promote early detection and intervention of osteonecrosis prior to joint collapse. Magnetic resonance imaging is regarded as a gold standard in the diagnosis of avascular necrosis both in symptomatic and silent. But the cost is a big burden for the average family in developing countries. It is particularly important to find sensitive and inexpensive indicators of avascular necrosis in the follow-up process of SLE patients. 

By reviewing three clinical cases of asymptomatic femoral head necrosis associated with childhood onset systemic lupus erythematosus in our hospital—including age at onset, disease severity, disease activity, corticosteroid use, Inflammatory cytokines,  erythrocyte sedimentation rates . we investigated the laboratory markers associated with avascular necrosis.

We discovered that in all these female pediatric systemic lupus erythematosus patients, asymptomatic femoral head necrosis was unintentionally discovered—and verified by magnetic resonance imaging —one year or even four years following the diagnosis of systemic lupus erythematosus, during times when there was no underlying disease activity. The patients' unexplained persistent elevated erythrocyte sedimentation rates prompted the order for magnetic resonance imaging .

When systemic lupus erythematosus patients have persistently elevated erythrocyte sedimentation rates but without clinical signs of disease activity—even if asymptomatic—Magnetic resonance imaging of the hip and knee joints can be used to determine whether asymptomatic avascular necrosis  is present.