What are the Jones diagnostic criteria for acute rheumatic fever (ARF)?

Updated: Dec 10, 2020
  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print
Answer

Guidelines for diagnosis published in 1944 by T. Duckett Jones [24] have been revised by the American Heart Association (AHA). The most recent update, published in 2015, recognizes the variability in clinical presentation in populations at different levels of risk and includes Doppler echocardiography as a tool to diagnose cardiac involvement; these changes bring the criteria into closer alignment with other international guidelines. [25]

Laboratory evidence of a preceding group A streptococcal infection is needed whenever possible. Without it, the diagnosis of ARF is in doubt, except in patients with chorea, which may be the sole initial manifestation of ARF, and rarely in patients with indolent rheumatic carditis with insidious onset and slow progression. [25]

The AHA suggests that diagnostic criteria may be applied differently, depending on rate of ARF or rheumatic heart disease (RHD) in the population. This can help avoid overdiagnosis in low-incidence populations and underdiagnosis in high-risk ones. The AHA defines low risk as an ARF incidence of < 2 per 100,000 school-aged children (usually 5–14 years old) per year or an all-age prevalence of RHD of ≤1 per 1000 population per year. Children not clearly from a low-risk population are at moderate to high risk depending on their reference population. [25]

Jones criteria for the diagnosis of initial ARF are the presence of two major manifestations or one major and two minor manifestations. For recurrent ARF, the criteria are two major manifestations, one major and two minor manifestations, or three minor manifestations.

Major manifestations comprise the following:

  • Carditis, clinical and/or subclinical (ie, detected by echocardiography)
  • Arthritis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules

In patients from low-risk populations, arthritis must be polyarthritis. For patients from moderate- and high-risk populations, either monoarthritis or polyarthritis qualifies; polyarthralgia may qualify if other causes have been excluded.

Minor manifestations in low-risk populations comprise the following:

  • Polyarthralgia
  • Fever ≥38.5°C
  • Acute phase reactions: Erythrocyte sedimentation rate (ESR) ≥60 mm in the first hour and/or C-reactive protein (CRP) level ≥3.0 mg/dL
  • Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)

Minor manifestations in moderate- and high-risk populations comprise the following:

  • Monoarthralgia
  • Fever ≥38°C
  • ESR ≥30 mm/h and/or CRP ≥3.0 mg/dL
  • Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!