In conclusion, arthralgias represent a rather common osteoarticular manifestation of primary and secondary APS, while arthritis is mainly described in SLE-related APS. Osteonecrosis is frequently described in association with aPL in patients with and without autoimmune disorders. The presence of osteonecrosis in primary APS patients in the absence of corticosteroid use suggests an association between osteonecrosis and APS. Clinicians should be aware of this possible clinical manifestation of APS, because early diagnosis may lead to early management. A systematic screening for aPL in all cases with diagnosed osteonecrosis in the absence of precipitating factors should be considered.