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    Jones Criteria for Acute Rheumatic Fever Diagnosis

    Diagnoses acute rheumatic fever based on major and minor criteria.
    When to Use
    • Use in initial attacks of acute rheumatic fever (ARF).
    • Do not use to measure rheumatic activity, establish the diagnosis of inactive or chronic rheumatic heart disease, or predict course or severity of disease.
    • An initial attack of ARF should not be diagnosed based on minor criteria.
    • Other illnesses may mimic ARF. Lab evidence of an antecedent group A streptococcal (GAS) infection (i.e., streptococcal antibody titers or positive throat culture or rapid strep test).
    • Intended only for the diagnosis of initial attacks of ARF.
    • A 2015 revision made modifications to the criteria, most notably providing two separate diagnostic pathways for those at low risk and those at moderate/high risk, and adding subclinical carditis as a major criterion. However, the 1992 (original) version remains popular in clinical use.
    Required Criteria

    At least 1 required for positive diagnosis.

    Major Criteria

    2+ required for positive diagnosis (or 1 with 2+ minor).

    Minor Criteria

    2+ required for positive diagnosis with 1+ major.

    Diagnostic Result:

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    Next Steps
    Creator Insights


    Cases of isolated chorea, indolent carditis, or recurrent attacks of rheumatic fever are more suggestive of rheumatic fever regardless of the presence of other Jones Criteria. In these scenarios, ARF is the presumptive diagnosis until proven otherwise.


    Selection of the appropriate criteria:

    Required Criterion
    Antecedent Group A Streptococcal infection Positive throat culture or rapid strep test, and/or
    Elevated or rising streptococcal antibody titer
    Major Criteria
    Erythema marginatum
    Subcutaneous nodules
    Minor Criteria
    Clinical Arthralgia
    Laboratory Elevated acute phase reactants
    Erythrocyte sedimentation rate
    C-reactive protein
    Prolonged PR interval

    Diagnosis is positive if antecedent GAS infection present AND at least 2 major criteria (or 1 major and 2 minor) are present.

    Dr. T. Duckett Jones

    About the Creator

    Thomas Duckett Jones, MD, (d. 1954) was the director of research in rheumatic fever and rheumatic heart disease at the House of the Good Samaritan in Boston for 20 years. He worked clinically at Massachusetts General Hospital and was on faculty at Harvard Medical School. Dr. Jones was appointed to the inaugural National Advisory Heart Council and also served as vice-president of the American Heart Association, chairman of the AHA's Council on Rheumatic Fever, and president-elect of the National Health Council.

    To view Dr. T. Duckett Jones's publications, visit PubMed

    About the Creator
    Dr. T. Duckett Jones