From the Guidelines
The major criteria for Jones criteria include carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules, while the minor criteria include polyarthralgia, fever, elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and prolonged PR interval on electrocardiogram (ECG) 1. The Jones criteria are diagnostic guidelines for acute rheumatic fever (ARF), a complication of untreated group A streptococcal infection.
Major Criteria
- Carditis (inflammation of the heart)
- Polyarthritis (inflammation of multiple joints)
- Chorea (involuntary movements)
- Erythema marginatum (a distinctive rash)
- Subcutaneous nodules
Minor Criteria
- Polyarthralgia (joint pain without inflammation)
- Fever (≥38°C)
- Elevated inflammatory markers (ESR ≥30 mm/h and/or CRP ≥3.0 mg/dL)
- Prolonged PR interval on ECG For a diagnosis of ARF, patients need either two major criteria or one major plus two minor criteria, along with evidence of a preceding streptococcal infection, as outlined in the revised Jones criteria 1. The criteria help distinguish ARF from other conditions with similar presentations, as ARF can lead to permanent heart valve damage if not properly diagnosed and treated. Key considerations in the diagnosis include:
- Evidence of preceding group A streptococcal infection
- Clinical and subclinical presentations of carditis
- Differentiation from other causes of similar symptoms, such as infective endocarditis or congenital heart anomalies The revised Jones criteria provide a framework for accurate diagnosis and treatment of ARF, emphasizing the importance of Doppler echocardiography in detecting subclinical carditis 1.
From the Research
Major Criteria for Jones Criteria
- Carditis 2, 3, 4, 5
- Polyarthritis 2, 3, 4
- Chorea 2, 3, 4
- Erythema marginatum 2, 3
- Subcutaneous nodules 2, 3
Minor Criteria for Jones Criteria
- Fever 2, 3
- Arthralgia 2, 3
- Laboratory findings of elevated erythrocyte sedimentation rate 2, 3
- Laboratory findings of C-reactive protein 2, 3
- Prolonged PR interval on ECG 2, 3
Diagnosis of Acute Rheumatic Fever
- Two major, or one major and two minor manifestations must be accompanied by supporting evidence of antecedent group A streptococcal infection 2, 3, 4
- Supporting evidence of antecedent group A streptococcal infection in the form of positive throat culture or elevated or rising anti-streptolysin titre 2, 3