Assess the precision of ChatGPT's responses regarding systemic lupus erythematosus (SLE) inquiries

Dear Editor,

1.

With the advancement of technology and information networks, young individuals are increasingly inclined to seek online health advice due to its convenience and efficiency in our fast‐paced lives. ChatGPT, as a prominent artificial intelligence model, has gained significant attention. It belongs to the Generative Pre‐trained Transformer (GPT) model family developed by OpenAI and has demonstrated immense potential in various domains, including education, healthcare, reasoning, text generation, and scientific research.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease primarily affecting women of childbearing age. Alongside facial rash, it can manifest symptoms such as fever, joint swelling and pain, kidney damage, and neurological manifestations. SLE is a global disease that increases the risk of premature death ¹ , particularly among young women. ² Given the complexity of clinical manifestations and the disease's heterogeneity, numerous questions surround SLE. Consequently, we compiled the most frequently asked questions about SLE by patients and their families and employed ChatGPT to provide answers, aiming to explore the accuracy of its responses.

2. METHODS

We selected 14 common questions and queried ChatGPT (ChatGPT‐3.5‐turbo mode) for answers, recording the generated responses (Table 1). Experienced rheumatology experts independently subjectively rated the answers on a scale of 0–10 (10 Highly accurate, 8 ≤ score<10: Relatively accurate, 6 ≤ score<8: Average, score<6: Inaccurate). The evaluation was conducted by five experts from July 18th, 2023 to July 21st, 2023. The experts did not receive any compensation for their participation.

TABLE 1.

SLE questions and ChatGPT's answers.

Item	Questions and ChatGPT's answers	WC	FKG	Score
Question 1	What are the main symptoms of SLE?
ChatGPT's answer	The main symptoms of Systemic Lupus Erythematosus (SLE) include: Fatigue and weakness: Patients often experience extreme fatigue that is difficult to alleviate even with rest. Joint pain and swelling: Most patients experience joint pain and swelling, especially in the fingers, wrists, knees, and ankles. Skin manifestations: SLE patients often have rashes, such as a butterfly‐shaped rash (appearing on the bridge of the nose and cheeks), photosensitive rash (worsened by exposure to sunlight), and skin ulcers. Photosensitivity: Patients are sensitive to sunlight or ultraviolet light, which can worsen skin symptoms. Kidney involvement: SLE can cause kidney damage, leading to nephritis and renal insufficiency. Cardiac and pulmonary symptoms: SLE patients may experience symptoms such as pericarditis, myocarditis, and pneumonia. Neurological symptoms: SLE can cause neurological symptoms such as headaches, memory loss, depression, and anxiety. Hematological abnormalities: SLE patients may have anemia, decreased platelets, and decreased white blood cells. Immune system abnormalities: SLE patients have abnormal immune system function, making them prone to infections and other autoimmune diseases. Please note that the symptoms and severity of SLE can vary from person to person, and different patients may exhibit different combinations of symptoms. If you suspect that you have SLE, it is important to seek medical attention promptly for diagnosis and treatment.	217	14.3	9.2
Question 2	What is the cause of SLE？
ChatGPT's answer	The exact cause of SLE is still unclear, but research suggests that it may be caused by a combination of various factors. Here are some possible causative factors: Genetic factors: Genetic factors play an important role in the development of SLE. Certain gene variations have been found to be associated with an increased risk of SLE. Immune system abnormalities: SLE is an autoimmune disease, where the immune system mistakenly attacks the body's own tissues and organs. Immune system abnormalities may be a key factor in the occurrence of SLE. Hormonal level changes: Changes in estrogen levels may be associated with the onset of SLE. Women of childbearing age have a higher risk of developing SLE, while the risk decreases after menopause. Environmental factors: Certain environmental factors may be associated with the development of SLE, such as exposure to ultraviolet radiation, infections, exposure to certain drugs and chemicals, etc. Trigger factors: SLE flares may be associated with certain trigger factors, such as infections, trauma, surgery, exposure to ultraviolet radiation, medications, etc. It is important to note that the above factors are just some possible causes, and the specific cause still requires further research and exploration.	199	13.3	9.2
Question 3	Is SLE caused by a weakened immune system?
ChatGPT's answer	SLE is not caused by a weakened immune system, but rather by immune system abnormalities leading to an autoimmune disease. In SLE patients, the immune system is dysregulated, resulting in the immune system mistakenly attacking the body's own tissues and organs, rather than a weakened immune response. In SLE, the immune system produces antibodies that attack the body's own cells and tissues, leading to inflammation and damage. These antibodies are called autoantibodies, with the most common being antinuclear antibodies (ANA). Immune system abnormalities in SLE may be associated with various factors such as genetic factors, environmental factors, and hormonal level changes. Although the immune system is abnormal in SLE patients, their immune response is not necessarily weakened. In fact, the immune system of SLE patients is often in an overactive state, leading to excessive inflammation and self‐tissue damage. Therefore, SLE is not caused by a weakened immune system, but rather by immune system abnormalities resulting in an autoimmune disease.	159	14	9
Question 4	What are the environmental factors that can cause SLE?
ChatGPT's answer	The environmental factors that can cause SLE may include the following: Ultraviolet (UV) exposure: Prolonged exposure to UV radiation may increase the risk of developing SLE. UV radiation can trigger abnormal immune responses, leading to the onset of SLE. Infections: Certain infections may be associated with the development of SLE. For example, viral infections (such as Epstein‐Barr virus, herpes simplex virus, etc.) and bacterial infections (such as streptococcal infections) can trigger abnormal immune responses, leading to SLE. Medications and chemicals: Certain medications and chemicals may be associated with the development of SLE. For example, certain antibiotics, antiepileptic drugs, antihypertensive medications, and certain chemicals (such as organic solvents, dyes, etc.) can induce abnormal immune responses, leading to SLE. Tobacco and alcohol: Smoking and excessive alcohol consumption may increase the risk of developing SLE. These habits can have adverse effects on the immune system, thereby increasing the risk of SLE. It is important to note that the role of environmental factors in the development of SLE still requires further research and exploration. Sensitivity to environmental factors may also vary among different individuals. Therefore, avoiding or reducing exposure to potential environmental factors can help lower the risk of developing SLE.	201	14.9	8.2
Question 5	What dietary considerations should be taken into account for SLE?
ChatGPT's answer	In terms of diet for SLE, the following points should be taken into consideration: Balanced diet: Maintaining a balanced diet is crucial for overall health. The diet should include an adequate amount of protein, carbohydrates, fats, vitamins, and minerals. A diverse diet can provide the body with various nutrients it needs. Weight control: Maintaining a healthy weight is important for SLE patients. Being overweight or obese may increase inflammation and joint burden, while being underweight can lead to malnutrition and weakened immune function. It is necessary to manage weight appropriately based on individual circumstances. Supplementation of vitamins and minerals: SLE patients may experience deficiencies in vitamins and minerals due to the disease and its treatment. Therefore, supplementing with appropriate amounts of vitamins and minerals such as vitamin D, calcium, folic acid, etc., can help maintain normal bodily functions. Limit salt intake: A high‐salt diet may contribute to edema and hypertension, which are common issues among SLE patients. Therefore, controlling salt intake is necessary. Avoid excessive alcohol consumption and smoking: Excessive alcohol consumption and smoking can exacerbate inflammation and abnormal immune responses, which are detrimental to the health of SLE patients. Therefore, it is advisable to avoid or limit the intake of alcohol and tobacco. It is important to note that diet alone cannot directly impact the disease activity of SLE. However, adopting good dietary habits can provide the body with necessary nutrients, maintain overall health, and contribute to the recovery and improvement of the quality of life for patients. If there are specific dietary requirements, it is recommended to consult with a healthcare professional or nutritionist for guidance.	273	13.3	7.2
Question 6	What are the commonly used medications for SLE treatment?
ChatGPT's answer	The treatment of SLE is usually comprehensive, and different medications may be used depending on the severity of the condition. The following are commonly used medications in the treatment of SLE: Nonsteroidal anti‐inflammatory drugs (NSAIDs): Used to alleviate joint pain and inflammation caused by SLE, such as ibuprofen, acetaminophen, etc. Glucocorticoids (such as prednisone): Used to control the inflammatory response and abnormal activity of the immune system in SLE. Glucocorticoids can relieve symptoms, but long‐term use may have some side effects. Immunosuppressants: Such as cyclophosphamide, azathioprine, etc., used to suppress abnormal immune activity, reduce inflammation, and autoimmune reactions. Antimalarial drugs: Such as hydroxychloroquine, chloroquine, etc., can be used to control symptoms such as skin lesions and joint pain, and also have immunomodulatory effects. Other immunomodulatory drugs: Such as methotrexate, Ginkgo biloba extract, etc., can be used to regulate the function of the immune system, alleviate inflammation, and autoimmune reactions. It is important to note that the specific treatment plan should be determined based on the patient's condition and the advice of the doctor. The medications for treating SLE may vary due to individual differences and may need to be adjusted based on changes in the condition. When using medications, it is important to follow the guidance of the doctor and undergo regular follow‐up visits and examinations.	221	15.6	7
Question 7	Is it necessary to use steroids for SLE treatment?
ChatGPT's answer	In the treatment of SLE, steroids (such as glucocorticoids) are commonly used medications, but not all SLE patients necessarily need to use steroids. The treatment plan should be determined based on the patient's specific condition and the severity of the disease. Steroids play a role in SLE treatment by suppressing abnormal immune activity and reducing inflammation, thereby alleviating symptoms and controlling disease progression. For some patients with mild SLE, short‐term or intermittent use of steroids may be sufficient to control symptoms. However, for patients with more severe disease or organ involvement, long‐term use of steroids may be necessary to control disease activity. However, long‐term use of steroids may have some side effects, such as osteoporosis, hypertension, diabetes, etc. Therefore, when using steroids, doctors usually weigh the benefits and risks based on the patient's condition and the risk of side effects, and strive to use the minimum effective dose and the shortest duration of treatment. In addition to steroids, there are other medications that can be used for SLE treatment, such as immunosuppressants, antimalarial drugs, etc. The specific treatment plan should be developed by the doctor based on the patient's condition. It is important to work closely with the doctor, follow their advice for treatment, and undergo regular follow‐up visits and examinations.	211	13.7	8
Question 8	Is lifelong medication necessary for SLE?
ChatGPT's answer	The treatment of SLE typically requires long‐term or even lifelong medication because SLE is a chronic autoimmune disease with no specific cure. The goal of medication treatment is to control disease activity, alleviate symptoms, prevent organ damage, and improve the patient's quality of life. The treatment plan for SLE is usually individualized based on the patient's condition and disease course. In general, patients need to use medication for an extended period to control disease activity. Commonly used medications include nonsteroidal anti‐inflammatory drugs, glucocorticoids, immunosuppressants, antimalarial drugs, and other immunomodulatory drugs. However, the treatment plan may be adjusted based on changes in disease activity and the patient's condition. Some patients may gradually reduce the dosage or discontinue medication after the disease enters a remission phase, but regular follow‐up visits and monitoring of disease activity are still necessary. It is important for patients to work closely with their doctors, follow their advice for treatment, and undergo regular follow‐up visits and examinations. Do not discontinue medication or change the dosage without medical guidance to avoid compromising disease control and overall health.	178	16.1	8.8
Question 9	How can SLE patients prevent infections?
ChatGPT's answer	SLE patients need to take extra precautions to prevent infections due to their compromised immune system. Here are some recommendations for infection prevention: Practice good personal hygiene: Maintain good personal hygiene habits, including frequent handwashing, keeping the body clean, and avoiding contact with pathogens. Avoid contact with sources of infection: Try to avoid contact with known infected individuals or animals, especially those with contagious diseases such as influenza or pneumonia. Get vaccinated: Receive appropriate vaccinations as advised by the doctor, such as influenza vaccines, pneumococcal vaccines, etc., to boost immunity. Avoid crowded places: Minimize visits to crowded places, especially during flu seasons or periods of epidemic outbreaks. Pay attention to food hygiene: Choose fresh, thoroughly cooked food, avoid raw or unclean food, and ensure food safety. Regular check‐ups: Regularly follow up with the doctor and undergo check‐ups to promptly detect and manage any potential infections. Use medications with caution: Follow the doctor's guidance and use immunosuppressants and other medications correctly to balance treatment effectiveness and infection risk. Maintain a healthy lifestyle: Get enough sleep, maintain a balanced diet, engage in moderate exercise, and enhance the body's immune system. It is important for SLE patients to work closely with their doctors to develop infection prevention measures that are suitable for their individual circumstances and seek medical attention promptly for any signs of infection.	230	15.5	8.4
Question 10	Can SLE patients receive vaccinations?
ChatGPT's answer	SLE patients can receive vaccinations, but the type and timing of vaccinations should be determined based on individual circumstances and the advice of a doctor. Generally, SLE patients can receive routine vaccinations such as influenza vaccines, pneumococcal vaccines, varicella vaccines, etc., which can help boost immunity and prevent corresponding infections. However, some vaccines may require special consideration for SLE patients. For example, live vaccines (such as measles, mumps, rubella vaccines) may not be suitable for administration during the use of immunosuppressants, as live vaccines can cause infections. Therefore, it is best to discuss with a doctor before receiving vaccinations to understand which vaccines are suitable for one's own situation. In addition, SLE patients may need to consider the following points when receiving vaccinations: 1. Timing of vaccination: It is preferable to receive vaccinations during periods of low disease activity or remission to avoid excessive stimulation of the immune system. 2. Immunosuppressants: If using immunosuppressants or other immunomodulatory medications, the dosage may need to be adjusted or temporarily discontinued to ensure the effectiveness of the vaccines. 3. Doctor's advice: Follow the advice of a doctor to develop a vaccination plan that is suitable for individual circumstances. In conclusion, SLE patients can receive vaccinations, but the type and timing of vaccinations should be determined based on individual circumstances and the guidance of a doctor. It is important to work closely with a doctor to develop an appropriate vaccination plan.	242	16.1	9
Question 11	Is SLE hereditary?
ChatGPT's answer	SLE (Systemic Lupus Erythematosus) has a certain genetic predisposition, but it is not solely determined by genetics. Genetic factors play a role in the development of SLE, but environmental factors are also important contributors to the disease. Research has shown that there may be other individuals with autoimmune diseases, such as rheumatoid arthritis and systemic sclerosis, in the families of SLE patients. This suggests that genetic factors play a role in the development of SLE. However, the pathogenesis of SLE is very complex and involves abnormal immune system responses and the interaction of various factors, including genetics and the environment. Environmental factors such as infections, medications, and exposure to ultraviolet radiation can also trigger or exacerbate SLE. Therefore, while SLE has a genetic predisposition, genetic factors are not the sole determining factor, and environmental factors are equally important. If there are SLE patients in the family, the individual's risk of developing the disease may be increased, but it does not mean that they will definitely develop SLE. It is important to closely monitor one's own health, undergo regular check‐ups, and consult with a doctor if there are SLE patients in the family.	192	15.1	9
Question 12	Can SLE patients conceive and how to plan a pregnancy scientifically?
ChatGPT's answer	SLE patients can conceive, but it is important to undergo scientific preconception planning and consult with a doctor. Here are some suggestions: Disease control: Before getting pregnant, it is best to have SLE disease activity under control. This can be achieved through appropriate use of medication, following the doctor's advice, and regular follow‐up visits. Consult with a doctor: Before planning a pregnancy, it is advisable to have detailed discussions and consultations with a doctor. The doctor can assess your disease condition, understand your treatment plan, and provide appropriate advice and guidance. Healthy lifestyle: Maintaining a healthy lifestyle is crucial for preconception and pregnancy. This includes a balanced diet, moderate exercise, adequate rest, and avoiding fatigue. Discontinuation of immunosuppressants: Some immunosuppressants may have potential risks to the fetus, so it may be necessary to discontinue or adjust the dosage of immunosuppressants before pregnancy. This should be done under the guidance of a doctor. Folic acid supplementation: Folic acid is essential for fetal development. It is recommended to supplement with folic acid during preconception and early pregnancy to prevent neural tube defects. Close monitoring: Once pregnant, SLE patients need to closely monitor their disease condition and fetal development. Regular follow‐up visits and examinations are necessary. In conclusion, SLE patients can conceive, but it is important to undergo scientific preconception planning under the guidance of a doctor. Disease control, consultation with a doctor, maintaining a healthy lifestyle, and close monitoring are important steps during preconception and pregnancy. Work closely with your doctor to develop a preconception plan that is suitable for you.	265	13.6	8.2
Question 13	Can SLE patients breastfeed after giving birth?
ChatGPT's answer	Can SLE patients choose to breastfeed after giving birth, but the decision should be made under the guidance of a doctor. Here are some relevant considerations: Disease activity: If SLE remains active after giving birth, it may have an impact on breastfeeding. Active SLE may require the use of immunosuppressants and other medications that could be passed to the baby through breast milk. In such cases, the doctor may advise temporarily stopping breastfeeding or adjusting the medication treatment plan. Medication treatment: Some medications may be passed to the baby through breast milk, potentially causing effects. When deciding whether to breastfeed, it is important to carefully assess the safety of medications and potential risks. The doctor can provide guidance based on your specific situation. Health condition: The health condition of SLE patients is also important in the decision to breastfeed. If your health condition is good and disease activity is stable, breastfeeding may be considered. However, if your health condition is unstable or there are other complications, the feasibility of breastfeeding may need to be reassessed. Baby's health: Breastfeeding is important for the baby's health. However, if your disease activity is unstable or requires medication treatment, it may have an impact on the baby. When deciding whether to breastfeed, the health of the baby and potential risks need to be considered. In conclusion, SLE patients can choose to breastfeed after giving birth, but the decision should be made under the guidance of a doctor. The doctor will assess the feasibility of breastfeeding based on factors such as disease activity, medication treatment, and health condition, and provide appropriate advice and guidance.	273	11.7	8.6
Question 14	Can SLE be cured?
ChatGPT's answer	Currently, SLE cannot be completely cured, but it can be controlled and managed through treatment to improve the patient's quality of life. Here are some common treatment methods: Medications: Commonly used medications include nonsteroidal anti‐inflammatory drugs (NSAIDs), antimalarials, immunosuppressants, and corticosteroids. These medications can help control inflammation and abnormal immune system activity. Immunosuppressants: For severe cases of SLE, immunosuppressants may be necessary to suppress excessive immune system activity. These medications can reduce inflammation and immune responses, but they should be used under the guidance of a doctor as they may have certain side effects on the immune system. Disease management: In addition to medication treatment, managing SLE also involves controlling disease activity, alleviating symptoms, preventing complications, and improving lifestyle. This includes regular follow‐up visits, following the doctor's advice, maintaining a healthy lifestyle, avoiding exposure to ultraviolet radiation, and reducing stress. Although SLE cannot be completely cured, most patients can control disease activity and live relatively normal lives through proper treatment and management. It is important to work closely with a doctor to develop a personalized treatment plan and undergo regular follow‐up visits and examinations to ensure effective disease control.	192	17.4	7.6

Abbreviations: WC, word count; FKG, Flesch‐Kincaid grade.

3. RESULTS

Each answer had an average word count of approximately 218 ± 35, with a Flesch‐Kincaid Grade Level of 14.6 ± 1.5, indicating a relatively high level of readability. The average score was 8.4 ± 0.7, suggesting a relatively accurate level of responses. However, it is regrettable that none of the 14 questions received a perfect score (Figure 1). To assess whether repeated questioning would yield different answers, we ran each of the 14 questions five times, and the results showed consistent answers with slight variations in sentence structure.

FIGURE 1.

Evaluation ChatGPT's answers’ scores.

The experts highlighted that ChatGPT's responses were not sufficiently comprehensive and precise in certain questions, particularly in questions 5, 6, and 14, where the average scores were below 8.

Question 5: What dietary considerations should be taken into account for SLE?

The most crucial dietary consideration for SLE is avoiding photosensitive foods, which contain metals like copper, iron, and zinc. These metals can absorb radiation from ultraviolet light, intensifying food absorbance. Consequently, consuming such foods may exacerbate skin damage in SLE patients. Unfortunately, ChatGPT did not mention this key point.

Question 6: What are the commonly used medications for SLE treatment?

ChatGPT's response mentioned nonsteroidal anti‐inflammatory drugs (NSAIDs), glucocorticoids, immunosuppressants, and immunomodulatory drugs. However, it failed to mention the use of biologics for treating SLE patients who exhibit poor response, intolerance, or relapse with immunosuppressive or immunomodulatory therapies. ³

Question 14: Can SLE be cured?

ChatGPT's answer was irrelevant to the question. While the question inquired about the possibility of a cure, the response discussed treatment methods. Furthermore, the answer regarding treatment methods was unsatisfactory. It mentioned immunosuppressive therapy as the first‐line treatment and redundantly referred to immunosuppressants as a treatment option. Additionally, the answer stated that only severe cases require immunomodulatory agents, whereas in clinical practice, especially when SLE involves the kidneys, even during stable disease stages, guidelines recommend the use of hydroxychloroquine or other equivalent antimalarial drugs for systemic lupus erythematosus and lupus nephritis patients, provided there are no contraindications. It is not limited to severe cases only. ⁴ The information provided by ChatGPT is not entirely accurate.

The inaccuracies in ChatGPT's responses to SLE‐related questions can be attributed to the following reasons:

1. ChatGPT relies on existing information and text, which may result in outdated information if recent research or advancements have occurred in the field.

2. ChatGPT lacks human‐like qualities. While it can simulate human conversation, it lacks genuine emotions and human‐like thinking capabilities required for complex reasoning and emotional expression. Consequently, it may not fully comprehend the question's meaning, leading to irrelevant responses.

4. LIMITATIONS

1. This study only evaluated commonly asked SLE questions and may not encompass all possible questions.

2. ChatGPT does not provide information sources, making it challenging for users to verify the accuracy of the information provided.

5. CONCLUSION

Our study found that ChatGPT can provide users with some useful and relatively accurate information about SLE. While the knowledge may not be up‐to‐date, it does not mislead users or delay treatment. We believe that as the text is updated, it will provide users with more accurate health information. SLE is a complex disease, and when it comes to important decisions, it is still advisable to rely on rheumatologists for guidance.

CONFLICT OF INTEREST STATEMENT

The authors have declared that no conflict of interest exists.

DATA AVAILABILITY STATEMENT

Data is available on request from the authors.