1. REVISED JONES CRITERIA 2002-2003 WHO Criteria for the Diagnosis of RF and RHD
Includes preceding streptococcal type A infection and a combination of major and minor clinical manifestations
Harrison’s Principles of Internal Medicine, 17th ed.

2. REVISED JONES CRITERIA 2002-2003 WHO Criteria for the Diagnosis of RF and RHD
MAJOR MANIFESTATIONS:
MINOR MANIFESTATIONS:
Carditis
Clinical: fever, polyarthralgia
Polyarthritis
Labs: elevated ESR, C-reactive protein (Acute Phase Reactants)
Chorea
Erythema Marginatum
ECG: prolonged P-R interval
Subcutaneous Nodules
SUPPORTING EVIDENCE OF A PRECEDING STREPTOCOCCAL INFECTION W/IN THE LAST 45 DAYS:
Elevated or rising anti-streptolysin O or other streptococcal antibody, or
(+) Throat culture, or
Rapid antigen test for group A streptococcus
*Revised Jones Criteria no longer include elevated leukocyte count and recent scarlet fever.
Carditis:
layers of cardiac tissue are affected (pericardium, epicardium, myocardium, endocardium)
Hallmark: Valvular Damage
Mitral valave almost always affected, sometimes with aortic valve
Characteristic manifestation: patient may have a new or changing murmur, with mitral regurgitation being the most common sometimes accompanied by aortic regurgitation.
Myocardial inflammation may affect electrical conduction pathways, leading to P-R interval prolongation (first-degree AV block or rarely higher-level block) and softening of the first heart sound.
Polyarthritis:
objective evidence of inflammation, with hot, swollen, red and/or tender joints and involvement of more than one joint
Characteristics: migratory; asymmetric; typically affects the knees, ankles, elbows and hips (large joints)
The joints are very painful and symptoms are very responsive to anti-inflammatory medicines
aseptic monoarthritis may be a presenting feature if anti-inflammatory medication is given early before the typical migratory pattern is established.
joint involvement that persists more than 1 or 2 days after starting salicylates is unlikely to be due to ARF
Chorea:
Also known as Syndenham´s chorea, or "St. Vitus´ dance"
There are abrupt, purposeless movements.
affect particularly the head (causing characteristic darting movements of the tongue) and the upper limbs
eventually resolves completely, usually within 6 weeks
This may be the only manifestation of ARF and is its presence is diagnostic. May also include emotional disturbances and inappropriate behavior.
Erythema marginatum:
A non-pruritic rash that commonly affects the trunk and proximal extremities, but spares the face
begins as pink macules that clear centrally, leaving a serpiginous, spreading edge. The rash is evanescent, appearing and disappearing before the examiner's eyes.
Subcutaneous nodules:
painless, firm, small (0.5–2 cm), mobile lumps beneath the skin overlying bony prominences, particularly of the hands, feet, elbows, occiput, and occasionally the vertebrae
They are a delayed manifestation, appearing 2–3 weeks after the onset of disease, last for just a few days up to 3 weeks
commonly associated with carditis
Harrison’s Principles of Internal Medicine, 17th ed.

3. DIAGNOSTIC CATEGORIES
REVISED JONES CRITERIA WHO Criteria for the Diagnosis of RF and RHD
DIAGNOSTIC CATEGORIES
Primary Episode of Rheumatic Fever
2 Major OR 1 Major + 2 Minor manifestations
Plus evidence of preceding group A streptococcal infection
Recurrent attack of RF in a patient without established RHD
Recurrent attack of RF in a patient with established RHD
2 Minor manifestations
Harrison’s Principles of Internal Medicine, 17th ed.

4. DIAGNOSTIC CATEGORIES
REVISED JONES CRITERIA WHO Criteria for the Diagnosis of RF and RHD
DIAGNOSTIC CATEGORIES
Rheumatic Chorea
Insidous onset rheumatic carditis
Other major manifestations or evidence of group A strep. infection not required
Infective endocarditis should be excluded.
Chronic valve lesions of RHD
Do not require any other criteria to be diagnosed as having rheumatic heart disease
Congenital heart disease should be excluded.
Harrison’s Principles of Internal Medicine, 17th ed.

5. REVISED JONES CRITERIA 2002-2003 WHO Criteria for the Diagnosis of RF and RHD
“Probable Rheumatic Fever”
with polyarthritis (or with only polyarthralgia or monoarthritis) and with several (3 or more) other minor manifestations, plus evidence of recent group A streptococcal infection.
may later turn out to be rheumatic fever
advise regular secondary prophylaxis, follow up closely and do regular heart examination (esp. in vulnerable age groups in high incidence settings)
Harrison’s Principles of Internal Medicine, 17th ed.