From the Guidelines
The Jones criteria should be used to diagnose acute rheumatic fever (ARF) by identifying two major manifestations or one major plus two minor manifestations in patients with evidence of preceding group A streptococcal (GAS) infection, as outlined in the 2015 American Heart Association scientific statement 1. The criteria consist of major and minor manifestations, with major criteria including carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules, and minor criteria including polyarthralgia, fever, elevated inflammatory markers (ESR or CRP), and prolonged PR interval on ECG. Key considerations in applying the Jones criteria include:
- Evidence of preceding GAS infection, which can be established through positive throat culture, rapid strep test, or elevated ASO titers
- The distinction between low-risk and moderate- to high-risk populations, with different criteria applied to each group
- The importance of excluding other causes of symptoms, particularly in the case of polyarthralgia
- The role of echocardiography in identifying subclinical carditis, which is defined as echocardiographic valvulitis 1. The diagnosis of ARF using the Jones criteria is critical to prevent long-term cardiac damage and to guide treatment, which typically includes antibiotics, anti-inflammatory agents, and bed rest for those with carditis, as well as long-term prophylaxis to prevent recurrence 1.
From the Research
Overview of the Jones Criteria
The Jones criteria are used to diagnose acute rheumatic fever based on major and minor criteria 2.
Diagnostic Criteria
The criteria have undergone several revisions, with the 2015 revision considering the risk within a population and offering two separate diagnostic pathways that prioritize specificity among those at low risk and sensitivity among those at moderate/high risk 3.
- For low-risk populations, subclinical carditis found on echocardiogram is a major criterion, in addition to carditis found clinically, and a body temperature of 38.5°C and above is a minor criterion 4.
- For moderate-high risk populations, subclinical carditis found on echocardiogram is a major criterion, in addition to clinical carditis, and aseptic monoarthritis and polyarthralgia are used as major criteria 4, 5.
- Minor criteria include a body temperature of 38°C and above, an erythrocyte sedimentation rate of 30 mm/h and above, and monoarhtralgia 4.
Importance of Echocardiography
Echocardiography is now recommended in all patients with suspected or confirmed acute rheumatic fever, and subclinical carditis can fulfill a major criterion for acute rheumatic fever in all populations 3, 5.
Recurrent Attacks
The diagnostic criteria for recurrent attacks have been updated, with three minor findings accepted in the presence of previous streptococcal infection, in addition to the old criteria 4.
Clinical Considerations
It is essential for physicians to make an accurate diagnosis of acute rheumatic fever using their own logic and assessment, in addition to the proposed criteria, especially in countries where the disease is prevalent 4.