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.

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.

DIAGNOSTIC CATEGORIES REVISED JONES CRITERIA 2002-2003 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.

DIAGNOSTIC CATEGORIES REVISED JONES CRITERIA 2002-2003 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.

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.