Rheumatic Fever (Jones Criteria)

Rheumatic fever is an inflammatory condition affecting many organ systems, but especially affecting the joints, heart, nervous system and skin. This condition occurs following beta hemolytic streptococcal infection (usually of the pharynx - e.g. Streptococcal Pharyngitis) and is an immune reaction. This condition typically is seen in ages 3-40 years, but is rare due to most individuals in developed countries due to early treatment of streptococcal infections. It most commonly begins ~20 days after streptococcal pharyngitis or scarlet fever.

Rheumatic Fever resolves in regard to inflammation of affected organs; however, damage may occur to heart valves which results in rheumatic heart disease.

The Jones Criteria should usually be met to make this diagnosis with at least the following being present:

Must have the Required Criteria
Must have either 2 Major criteria or 1 Major criteria PLUS 2 Minor criteria.

Required Criteria

Evidence of recent Group A Beta Hemolytic Streptococcus (GABHS) infection
Positive and rising ASO titer
Positive GABHS throat culture
Recent scarlet fever
Positive anti-deoxyribonuclease B or anti-hyaluronidase

Major Criteria

Carditis (Inflammation of the heart; may have CHF, pericarditis, friction rub, new heart murmur)
Migratory Polyarthritis (Inflammatory arthritis, usually affecting large joints, usually first in the lower extremities)
Chorea (Involuntary rapid movements of the face or arms; typically late in the course of disease)
Erythema marginatum (Rash on trunk &/or arms that is macular, with central aspect of lesions having clearing)
Subcutaneous nodules (Usually involve back of wrist, lateral elbow, anterior knee and are painless, firm collections of collagen fibers)

Minor Criteria

Fever
Arthralgia
Prolonged PR on EKG
Previous rheumatic fever or rheumatic heart disease
Elevation of acute phase reactants (ESR, CRP, Leukocytosis)

Reference:

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. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. JAMA. 21 October 1992;268(15):2069-73.

Evidence of recent Streptococcus infection	Yes No
Major Criteria	☐Carditis ☐Migratory Polyarthritis ☐Chorea ☐Erythema marginatum ☐Subcutaneous nodules
Minor Criteria	☐Fever ☐Arthralgia ☐Prolonged PR on EKG ☐Previous rheumatic fever or rheumatic heart disease ☐Elevation Of Acute phase reactants (ESR, CRP, Leukocytosis)

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