The daily educational pearl – Jones criteria rheumatic fever

The diagnosis of rheumatic fever can be made when 2 major criteria, or 1 major criterion plus 2 minor criteria, are present as well as evidence of previous streptococcal infection. The are known as revised Jones criteria.

In a patient with previous rheumatic heart disease, a recurrent episode can be diagnosed when 2 major criteria, or 1 major criterion plus 2 minor criteria, or 3 minor criteria, are present as well as evidence of previous streptococcal infection.

Major criteria

Polyarthritis: asymmetrical, migrating inflammation of the large joints, usually knees or ankles

– Carditis: congestive heart failure with shortness of breath and resting tachycardia,  pericarditis, new heart murmur, excluding evidence of valvulitis on echo

Subcutaneous nodules: small, round, painless, firm nodules over elbows, wrists, knees, ankles

Erythema marginatum: circular or serpinginous bright pink macules or papules on the trunk; it usually spares the face and is made worse by heat

Sydenham’s chorea (St. Vitus’ dance): jerky, uncoordinated, rapid movements, more commonly affecting the tongue, hand, feet and face; they can be unilateral and disappear when patient is asleep

If present, chorea does not require other manifestations or evidence of preceding GAS infection, provided other causes of chorea are excluded.

 

Minor criteria

Fever > 38°C

Polyarthralgia or monoarthritis and not meeting major criteria features

ESR ≥ 30 mmHg OR C reactive protein ≥ 30 mg/L

Prolonged PR interval and carditis not diagnosed

Rheumatic Heart Disease (RHD) Australia have recently published the 2nd edition of diagnostic and management guidelines for acute rheumatic fever.

The new guidelines include slightly different diagnostic criteria for high risk populations:

Differences in major criteria

Carditis: congestive heart failure with shortness of breath and resting tachycardia, pericarditis or a new heart murmur, INCLUDING  evidence of valvulitis on echo

Arthritis: including monoarthritis or polyarthralgia

Differences in minor criteria

Monoarthralgia

 

High-risk populations are considered:

– those living in communities with high rates of acute rheumatic fever or rheumatic heart disease

– Aboriginal people and Torres Strait Islanders living in rural or remote settings

Potentially high risk (data not available) – Aboriginal people and Torres Strait Islanders living in urban settings, Maoris and Pacific Islanders, immigrants from developing countries

 

 

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