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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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