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Jones Criteria for Acute Rheumatic Fever Diagnosis
2015 revised criteria for diagnosing acute rheumatic fever, stratified by population risk.
Jones Criteria for Acute Rheumatic Fever Diagnosis
Population risk category
Criteria for arthritis and minor manifestations differ between the two risk groups.
Recurrent ARF in a patient with known past ARF or rheumatic heart disease
Evidence of a preceding group A streptococcal infection (culture, rapid antigen test, or rising/elevated antibody titer)
Required for diagnosis of an initial episode; not required for the '3 minor manifestations' recurrence pathway if GAS evidence is otherwise unobtainable.
Major: carditis (clinical and/or subclinical on echocardiography)
Major: arthritis (polyarthritis if low risk; mono-, poly-, or polyarthralgia if moderate/high risk)
Major: Sydenham chorea
Major: erythema marginatum
Major: subcutaneous nodules
Minor: arthralgia (monoarthralgia if moderate/high risk; polyarthralgia if low risk) not already counted as a major criterion
Minor: fever (>=38.0C moderate/high risk; >=38.5C low risk)
Minor: elevated ESR (>=30 moderate/high risk, >=60 low risk) and/or CRP >=3.0 mg/dL
Minor: prolonged PR interval for age (unless carditis is a major criterion)
ResultCriteria not met
0 major and 0 minor manifestation(s): does not fulfil the 2015 Jones criteria for acute rheumatic fever.
- Major criteria met
- 0
- Minor criteria met
- 0
When to use
- Diagnosing an initial or recurrent episode of acute rheumatic fever in a patient with compatible clinical findings.
Formula
Initial ARF: 2 major, or 1 major + 2 minor, plus evidence of preceding GAS infection. Recurrent ARF: as above, or 3 minor manifestations alone. Major/minor definitions and thresholds vary by population risk (low vs moderate/high).
Pearls and pitfalls
- Echocardiography is now incorporated (subclinical carditis counts as a major criterion even without auscultatory findings).
- A manifestation cannot count as both a major and a minor criterion simultaneously (e.g., arthritis vs. arthralgia, or carditis vs. prolonged PR).