rheumatology paediatrics cardiology

Jones Criteria for Acute Rheumatic Fever Diagnosis

Revised Jones criteria (AHA 2015) for acute rheumatic fever (ARF): evidence of preceding group A streptococcal infection plus 2 major, or 1 major and 2 minor manifestations (recurrent ARF: also 3 minor). Major and minor definitions differ for low-risk populations (ARF incidence ≤ 2 per 100 000 school-age children a year, or rheumatic heart disease prevalence ≤ 1 per 1000) and moderate/high-risk populations.

Evidence of preceding Group A streptococcal pharyngitis (mandatory precondition)*

Episode*

MAJOR — Carditis (clinical or subclinical/echocardiographic mitral or aortic regurgitation)*

MAJOR — Arthritis: low-risk population — polyarthritis; moderate/high-risk — monoarthritis, polyarthritis or polyarthralgia*

MAJOR — Chorea (Sydenham's chorea — involuntary movements)*

MAJOR — Erythema marginatum*

MAJOR — Subcutaneous nodules*

MINOR — Arthralgia: low-risk — polyarthralgia; moderate/high-risk — monoarthralgia (not counted when arthritis is counted as major)*

MINOR — Fever: low-risk population ≥ 38.5 °C; moderate/high-risk ≥ 38 °C*

MINOR — Raised inflammatory markers: low-risk ESR ≥ 60 mm/h and/or CRP ≥ 3.0 mg/dL (30 mg/L); moderate/high-risk ESR ≥ 30 mm/h and/or CRP ≥ 3.0 mg/dL*

MINOR — Prolonged PR interval for age (not counted when carditis is counted as major)*

Score interpretation

Cannot Diagnose — No Evidence of Preceding GAS Infection -1

ARF cannot be diagnosed without evidence of preceding group A streptococcal infection.

→ Test: throat culture or rapid antigen test, raised or rising ASO or anti-DNase B titres; reassess with the results.

Jones Criteria Not Met 0

Jones criteria not fulfilled for ARF

→ Consider alternative diagnoses (reactive arthritis, JIA, septic arthritis, SLE, Lyme disease); treat any confirmed GAS infection with amoxicillin or penicillin V; follow-up ESR, ASO titre

Acute Rheumatic Fever — Jones Criteria Met 1

Evidence of preceding GAS infection with 2 major, 1 major + 2 minor, or (recurrent ARF) 3 minor manifestations.

→ ARF diagnosed. Admit for monitoring; echocardiography for all (subclinical carditis counts). Eradicate group A streptococcus — Adults: benzathine benzylpenicillin 1.2 MU IM once (or phenoxymethylpenicillin orally for 10 days). Anti-inflammatory treatment for arthritis (aspirin or naproxen). Prednisolone for severe carditis. Secondary prophylaxis: benzathine penicillin or phenoxymethylpenicillin (duration based on carditis severity: 5 years to lifelong); cardiology and rheumatology follow-up. Children: use a children's formulary.

Interpretation bands for the Jones Criteria. Apply clinical judgement and local guidance.

References

Gewitz MH et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography. Circulation. 2015;131(20):1806–1818.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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