rheumatology paediatrics cardiology

Jones Criteria for Acute Rheumatic Fever Diagnosis

Modified Jones Criteria (2015 AHA) for diagnosing first episode of acute rheumatic fever (ARF). Requires evidence of preceding streptococcal infection PLUS major/minor criteria as specified.

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

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

MAJOR — Polyarthritis (≥3 joints; migratory, acute, painful joints); or monoarthritis/polyarthralgia in high-risk populations*

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

MAJOR — Erythema marginatum*

MAJOR — Subcutaneous nodules*

MINOR — Fever (≥38.5°C)*

MINOR — Elevated ESR (≥60 mm/h) or CRP (>3.0 mg/dL or >30 mg/L)*

MINOR — Prolonged PR interval on ECG (age-adjusted; not if carditis is a major criterion)*

Score interpretation

Criteria Not Met 0–1

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

Apply Jones Criteria 2–10

Jones Criteria points present — apply 2 major / 1 major + 2 minor / 3 minor rule

→ If strep evidence AND criteria met: ARF diagnosed. Admit for monitoring. Benzylpenicillin 1.2 MU IM stat + penicillin V oral × 10 days. Aspirin for arthritis (80–100 mg/kg/day). Prednisolone for severe carditis. Echo mandatory if carditis suspected. Secondary prophylaxis: phenoxymethylpenicillin/benzathine penicillin (duration based on carditis severity: 5 years to lifelong); cardiology and rheumatology follow-up

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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