Revised Jones Criteria for Diagnosis of Rheumatic Fever : 2015 : Summary easy to understand

Revised Jones Criteria for Diagnosis of Rheumatic Fever

                                                  

                                                                Dr Efra Abbas

We in Lahore, Pakistan , have a High Risk population for occurrence of Rheumatic Fever.                  

•         Low risk population

▫         ARF incidence <2 per 100,000

•         High risk population

▫         Children not clearly from a low-risk population are at moderate to high risk depending on their reference population

▫         >2/100000 arf or rhd prevlance >1 /1000

Major Manifestation	Minor Manifestations	Evidence of Antecedent Grp A Streptococcal infection
Carditis Polyarthritis Erythema marginatum Subcutaneous nodules Chorea	Arthralgia Fever Elevated ESR/CRP Prolonged PR interval	Positive throat culture or Rapid Streptococcal antigen test Elevated or increasing streptococcal antibody titer

Initial Attack:

•         2 major

•         1 major and 2 minor

•         With evidence of recent GAS

Subsequent Attack :

•         2 major

•         1 major ,2 minor

•         3 MINOR IN HIGH / MODERATE RISK POPULATION

•         Plus preceding GAS

CARDITIS:
2 major

•         1 major ,2 minor

•         3 MINOR IN HIGH / MODERATE RISK POPULATION

•         Plus preceding GAS

So,

Echocardiography/Doppler testing should be performed to assess whether carditis is present in the absence of auscultatory findings, particularly in moderate- to high-risk populations and when ARF is considered likely

ARTHRITIS:

Migratory polyarthritis , large joints , disproportionate pain, non deforming

•         Low risk : polyarthritis

•         High risk :

▫         Monoarthritis in the absence of prior inflamatory therapies

▫         Polyarthralgia  when other causes are excluded

Minor criteria: low risk population

•         Minor criteria:

•         Polyarthralgia

•         fever (≥38.5° F) 101.3 deg Fahrenheit

•         sedimentation rate ≥60 mm

•          C-reactive protein (CRP) ≥3.0 mg/dl

•         prolonged PR interval (unless carditis is a major criterion

•          

Minor criteria: high risk

•         Minor criteria:

•         fever (≥38° F)  100.4 deg Fahrenheit

•         sedimentation rate ≥30 mm

•          CRP ≥3.0 mg/dl

•         prolonged PR interval (unless carditis is a major criterion)

Evidence of preceding Streptococcal infection

•         Increased or rising anti-streptolysin O titer or other streptococcal antibodies (anti-DNASE B) (Class I, Level of Evidence B).

•          A positive throat culture for group A β-hemolytic streptococci (Class I, Level of Evidence B).

•          A positive rapid group A streptococcal antigen test in a child whose clinical presentation suggests  streptococcal pharyngitis (Class I, Level of Evidence B)

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