The management of a patient with SLE presents the OMS with a challenging array of decisions to make in regards to treatment sequencing. Careful reviews of the patient's medical history, the presentation of the illness, and the medication profile, and an open discourse with medical colleagues are necessary to ensure the safety of patients. By becoming comfortable with the medical treatment the patient is undergoing as well as having a firm understanding of where the patient is along the cascade of disease severity (see Fig. 7), appropriate decisions can be made in regards to the patient's outcome and prognosis. Proceeding into surgical treatment without following these guidelines could potentially result in catastrophic consequences for the patient.