Unifying Concepts

Revised Jones Criteria for Acute Rheumatic Fever (ARF)

A firm diagnosis requires that two major or one major and two minor criteria are satisfied, in addition to evidence of recent streptococcal infection.

Major Criteria

  1. Carditis: All layers of cardiac tissue are affected (pericardium, epicardium, myocardium, endocardium) The patient may have a new or changing murmur, with mitral regurgitation being the most common followed by aortic insufficiency.
  2. Polyarthritis: Migrating arthritis that typically affects the knees, ankles, elbows and wrists. The joints are very painful and symptoms are very responsive to anti-inflammatory medicines.
  3. Chorea: Also known as Syndenham´s chorea, or “St. Vitus´ dance”. There are abrupt, purposeless movements. This may be the only manifestation of ARF and is its presence is diagnostic. May also include emotional disturbances and inappropriate behavior.
  4. Erythema marginatum: A non-pruritic rash that commonly affects the trunk and proximal extremities, but spares the face. The rash typically migrates from central areas to periphery, and has well-defined borders.
  5. Subcutaneous nodules: Usually located over bones or tendons, these nodules are painless and firm.

Minor Criteria:

  1. Fever
  2. Arthralgia
  3. Previous rheumatic fever or rheumatic heart disease
  4. Acute phase reactants: Leukocytosis, elevated eritrosedimentation rate (ESR) and C-reactive protein (CRP)
  5. Prolonged P-R interval on electrocardiogram (ECG)

Evidence of preceding streptococcal infection: Any one of the following is considered adequate evidence of infection:

  • Increased antistreptolysin O or other streptococcal antibodies
  • Positive throat culture for Group A beta-hemolytic streptococci
  • Positive rapid direct Group A strep carbohydrate antigen test
  • Recent scarlet fever.



  1. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. 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. JAMA. 1992 Oct 21;268(15):2069-73. [Medline]
Created: Jul 14, 2005
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