How do you decide which children need early steroid-sparing therapy rather than hydroxychloroquine plus a short steroid course in pediatric non-renal SLE?

Unfortunately, the majority of our pediatric systemic lupus erythematosus patients have renal disease. Of those who do not, I cannot think of anyone I only treated with hydroxychloroquine after a brief steroid burst. If they have systemic disease, they need a DMARD to spare steroids beyond hydroxych...