Table 2.
The Jones Criteria 2015 for the diagnosis of rheumatic fever
| Criteria | Patient population* | Manifestations |
|---|---|---|
| Major | Low risk‡ | • Carditis§ (clinical and/or subclinical§) • Arthritis (polyarthritis only) • Chorea • Erythema marginatum • Subcutaneous nodules |
| Moderate and high risk | • Carditis (clinical and/or subclinical) • Arthritis (including monoarthritis, polyarthritis or polyarthralgia‖) • Chorea • Erythema marginatum • Subcutaneous nodules |
|
| Minor | Low risk‡ | • Polyarthralgia • Fever (≥38.5 °C) • An ESR of ≥60 mm per hour and/or CRP of ≥3.0 mg per dL¶ • Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion) |
| Moderate and high risk | • Monoarthralgia • Fever (≥38 °C) • An ESR of ≥30 mm per hr and/or CRP of ≥3.0 mg per dL¶ • Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion) |
As in the past Jones Criteria versions, it should be recalled that erythema marginatum and subcutaneous nodules are rarely ‘stand alone’ major criteria. In addition, joint manifestations can only be considered in either the major or minor categories but not both in the same patient. ARF, acute rheumatic fever; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; RHD, rheumatic heart disease.
For all patient populations with evidence of preceding group A Streptococcus infection, diagnosis of initial ARF requires two major manifestations or one major plus two minor manifestations. Diagnosis of recurrent ARF requires either two major manifestations, one major and two minor manifestations or three minor manifestations.
Annual ARF incidence of ≤2 per 100,000 school-aged children or all age RHD prevalence of ≤1 per 1,000 people per year.
Defined as echocardiographic valvulitis.
Polyarthralgia should only be considered as a major manifestation in moderate and high risk populations after exclusion of other causes.
CRP value must be greater than the normal laboratory upper limit. In addition, as the ESR might evolve during the course of ARF, peak ESR values should be used.