The 2015 Jones Criteria for Acute Rheumatic Fever (ARF)

The changes improve the diagnosis of ARF among moderate/high-risk populations and re-establish the Jones criteria as the international gold standard for ARF diagnosis.

2015 Revised Jones Criteria

A. For all patient populations with evidence of preceding GAS infection

Diagnosis: initial ARF

Diagnosis: recurrent ARF

2 Major manifestations or 1 major plus 2 minor manifestations

2 Major or 1 major and 2 minor or 3 minor

B. Major criteria
Low-risk populations*
Carditis†
• Clinical and/or subclinical
Arthritis
• Polyarthritis only
Chorea
Erythema marginatum
Subcutaneous nodules
Moderate- and high-risk populations
Carditis
• Clinical and/or subclinical
Arthritis
• Monoarthritis or polyarthritis
• Polyarthralgia‡
Chorea
Erythema marginatum
Subcutaneous nodules
C. Minor criteria
Low-risk populations*
Polyarthralgia
Fever (≥38.5°C)
ESR ≥60 mm in the first hour and/or CRP ≥3.0 mg/dL§
Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)
Moderate- and high-risk populations
Monoarthralgia
Fever (≥38°C)
ESR ≥30 mm/h and/or CRP ≥3.0 mg/dL§
Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)

ARF indicates acute rheumatic fever; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; and GAS, group A streptococcal infection.
*Low-risk populations are those with ARF incidence ≤2 per 100 000 school-aged children or all-age rheumatic heart disease prevalence of ≤1 per 1000 population per year.
†Subclinical carditis indicates echocardiographic valvulitis.
‡As in past versions of the criteria, erythema marginatum and subcutaneous nodules are rarely “stand-alone” major criteria. Additionally, joint manifestations can only be considered in either the major or minor categories but not both in the same patient.
§CRP value must be greater than upper limit of normal for laboratory. Also, because ESR may evolve during the course of ARF, peak ESR values should be used.

 

 

References:

  1. 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 May 19;131(20):1806-18. [Medline]
  2. Beaton A, Carapetis J. The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries. Heart Asia. 2015 Aug 19;7(2):7-11. [Medline]

 

Created Mar 15, 2018.

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