From the Guidelines
The Jones criteria are diagnostic guidelines used to identify acute rheumatic fever (ARF), a delayed inflammatory complication following group A streptococcal pharyngitis, and include major manifestations (carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules) and minor manifestations (fever, arthralgia, elevated inflammatory markers, and prolonged PR interval on ECG) as outlined in the 2015 revision 1.
Key Components of the Jones Criteria
- Major manifestations: carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules
- Minor manifestations: fever, arthralgia, elevated inflammatory markers (such as ESR ≥60 mm in the first hour and/or CRP ≥3.0 mg/dL), and prolonged PR interval on ECG
Diagnostic Requirements
A diagnosis of ARF typically requires evidence of a preceding streptococcal infection plus either:
- Two major criteria
- One major and two minor criteria
Population Considerations
The 2015 revision introduced different standards for low-risk and high-risk populations, recognizing that ARF remains prevalent in developing regions while rare in developed countries 1.
Importance of the Jones Criteria
These criteria are essential for early diagnosis and treatment of ARF to prevent long-term cardiac damage, particularly rheumatic heart disease, which can result from untreated or recurrent ARF 1.
From the Research
Jones Criteria Overview
The Jones criteria are guidelines used to diagnose acute rheumatic fever (ARF), which is an inflammatory disease that can occur after a group A streptococcal infection. The criteria were first proposed by Dr. T. Duckett Jones in 1944 and have been modified several times since then 2, 3.
Major and Minor Manifestations
The Jones criteria include major and minor manifestations of ARF. The major manifestations are:
- Carditis
- Polyarthritis
- Chorea
- Erythema marginatum
- Subcutaneous nodules The minor manifestations include:
- Fever
- Arthralgia
- Laboratory findings of elevated erythrocyte sedimentation rate, C-reactive protein, and prolonged PR interval on ECG 2, 3.
Diagnostic Criteria
To diagnose ARF using the Jones criteria, two major manifestations or one major and two minor manifestations must be present, along with evidence of antecedent group A streptococcal infection, such as a positive throat culture or elevated anti-streptolysin titre 2, 3.
Updates to the Jones Criteria
The Jones criteria have been updated several times, with the most recent revision in 2015. This revision considers the risk of ARF within a population and offers two separate diagnostic pathways, one for low-risk populations and one for moderate to high-risk populations. Echocardiography is now recommended in all patients with suspected or confirmed ARF, and subclinical carditis can fulfill a major criterion for ARF in all populations 4.
Importance of the Jones Criteria
The Jones criteria are important for diagnosing ARF, as the disease can have significant morbidity and mortality, particularly in developing countries. The criteria help clinicians diagnose ARF and distinguish it from other diseases with similar symptoms, such as Lyme disease and serum sickness 5.
Key Points
- The Jones criteria are guidelines for diagnosing acute rheumatic fever (ARF) 2, 3.
- The criteria include major and minor manifestations of ARF, as well as evidence of antecedent group A streptococcal infection 2, 3.
- The Jones criteria have been updated several times, with the most recent revision in 2015 4.
- Echocardiography is now recommended in all patients with suspected or confirmed ARF 4.
- The Jones criteria are important for diagnosing ARF and distinguishing it from other diseases with similar symptoms 5.