Jones criteria for diagnosis of acute rheumatic fever

Jones criteria for diagnosis of acute rheumatic fever

Jones criteria for the diagnosis of acute rheumatic fever was first published in 1944 [1]. Major manifestations described in this paper were carditis, arthralgia, chorea, subcutaneous nodules and recurrences of rheumatic fever. Minor manifestations were fever, abdominal pain, precordial pain, rashes, epistaxis, pulmonary findings and laboratory findings. The diagnosis of rheumatic fever was considered reasonable if there was: 1) Any combination of major manifestations 2) Combination of one major and two minor manifestations 3) Minor manifestations alone, in the presence of rheumatic heart disease, when other causes can be excluded.

Over the years, the original Jones criteria for the diagnosis of rheumatic fever have been revised and modified several times. The 1992 update was by a special writing group headed by Dajani AS et al [2]. According to the 1992 update, the major manifestations were carditis, polyarthritis, chorea, erythema marginatum and subcutaneous nodules. The minor manifestations were grouped into clinical findings and laboratory findings. The clinical findings were arthralgia and fever. The laboratory findings were elevated acute phase reactants (erythrocyte sedimentation rate, C-reactive protein) and prolonged PR Interval. In addition supporting evidence of antecedent Group A streptococcal infection were included as positive throat culture or rapid streptococcal antigen test and elevated or rising streptococcal antibody titer. The presence of two major manifestations or of one major and two minor manifestations indicates a high probability of acute rheumatic fever, if there is evidence of a preceding group A streptococcal infection.

In 2000 another working group chaired by Patricia Ferrieri was set up by the American Heart Association, to see whether further revision was required. The report was published in Circulation [3]. They were of the opinion that there was no need to revise the criteria for the diagnosis of first episode of rheumatic fever. They also concluded that although echocardiography was useful in the evaluation of rheumatic heart disease, the evidence did not favour including echocardiographic findings as major or minor diagnostic criteria.

American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young has revised the criteria again in 2015 [4]. This time echocardiography has been given a role in the diagnosis of subclinical carditis.

References

1. Jones TD. The diagnosis of rheumatic fever. J Am Med Assoc. 1944;126(8):481-484.
2. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association (1992) Guidelines for the diagnosis of acute rheumatic fever: Jones criteria, 1992 update. JAMA 268:2069–2073.
3. Patricia Ferrieri, Jones Criteria Working Group. Proceedings of the Jones Criteria workshop. Circulation. 2002 Nov 5;106(19):2521-3.
4. Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, Remenyi B, Taubert KA, Bolger AF, Beerman L, Mayosi BM, Beaton A, Pandian NG, Kaplan EL; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography: A Scientific Statement From the American Heart Association. Circulation. 2015; 131: 1806-1818.