Jones criteria

The Jones Criteria for guidance in the diagnosis of acute rheumatic fever were first published by T. Duckett Jones, MD, in 1944 and have been revised over the years by the American Heart Association. The current guidelines are an update of these criteria.

The Jones criteria are used to diagnose rheumatic fever.

Jones criteria 

The 5 major criteria consist of the following:

• Carditis
• Polyarthritis
• Chorea
• Erythema marginatum
• Subcutaneous nodules

The minor criteria include the following:

• Fever
• Arthralgia
• Elevated erythrocyte sedimentation rate or C-reactive protein level
• Prolonged PR interval on electrocardiogram (ECG)

The presence of 2 major manifestations or of 1 major and 2 minor manifestations, supported by evidence of a preceding GAS infection by positive throat swab or culture results or by high serum ASO titers, strongly suggests ARF.

📖 Firestein & Kelley’s Textbook of Rheumatology 

When to Use:

• Use in the diagnosis of suspected acute rheumatic fever (ARF).
• Diagnosis of ARF is a clinical diagnosis based on these standard diagnostic criteria.
• Do not use to measure rheumatic activity, establish the diagnosis of inactive or chronic rheumatic heart disease, or to predict the course or severity of the disease.

Pitfalls:

• An initial presentation of possible ARF should not be diagnosed based on minor criteria alone.
• Other illnesses may mimic ARF. Laboratory evidence of an antecedent group A streptococcal (GAS) infection (i.e., streptococcal antibody titers, positive throat culture or rapid Strep test) is mandatory to establish the diagnosis.
• Only GAS infections of the upper respiratory tract lead to ARF; GAS skin infections do not lead to ARF.
• A 2015 revision made modifications to the criteria, most notably providing two separate diagnostic pathways for those at low risk and those at moderate/high risk, and adding subclinical carditis as a major criterion. However, the 1992 (original) version remains popular in clinical use.
• Children less than 3 years of age are unlikely to develop an autoimmune response that leads to ARF. Even with laboratory evidence of GAS infection, consider other diagnoses first. Expert consultation with pediatric infectious disease, cardiology, and/or rheumatology may be helpful.
• Myocarditis without valvulitis (without new murmur or echo evidence suggestive of RHD) is unlikely to be rheumatic in origin.

Why Use:

• Increased or rising anti-streptolysin O titer or other streptococcal antibodies (anti-DNASE B).
• A positive rapid group A streptococcal (GAS) carbohydrate antigen test in a child whose clinical presentation suggests a high pretest probability of streptococcal pharyngitis.
• A positive throat culture for group A β-hemolytic streptococci.
  
  

Thomas Duckett Jones, MD, (d. 1954) was the director of research in rheumatic fever and rheumatic heart disease at the House of the Good Samaritan in Boston for 20 years. 

Thomas Duckett Jones

He worked clinically at Massachusetts General Hospital and was on faculty at Harvard Medical School. Dr. Jones was appointed to the inaugural National Advisory Heart Council and also served as vice-president of the American Heart Association, chairman of the AHA's Council on Rheumatic Fever, and president-elect of the National Health Council.

References

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doi: 10.3928/00904481-20150611-01. PMID: 26114361.

2: Jones SA, Lueras JM, Nagel BJ. Effects of Binge Drinking on the Developing

Brain. Alcohol Res. 2018;39(1):87-96. PMID: 30557151; PMCID: PMC6104956.

3: Murube J. Criteria for diagnosis of Sjogren-Jones syndromes. Ocul Surf. 2011

Apr;9(2):61-9. doi: 10.1016/s1542-0124(11)70013-1. PMID: 21545760.

4: Stewart T, McDonald R, Currie B. Use of the Jones Criteria in the diagnosis

of acute rheumatic fever in an Australian rural setting. Aust N Z J Public

Health. 2005 Dec;29(6):526-9. doi: 10.1111/j.1467-842x.2005.tb00244.x. PMID:

16366063.

5: Hawkins E, Jones A. What is the role of the physiotherapist in paediatric

intensive care units? A systematic review of the evidence for respiratory and

rehabilitation interventions for mechanically ventilated patients.

Physiotherapy. 2015 Dec;101(4):303-9. doi: 10.1016/j.physio.2015.04.001. Epub

2015 Apr 14. PMID: 26051847.

6: Jones P. Hypertension. Br J Gen Pract. 2012 Dec;62(605):629. doi:

10.3399/bjgp12X659213. PMID: 23211243; PMCID: PMC3505393.

7: Jones BE, Jones JP, Vines CG, Dean NC. Validating hospital admission criteria

for decision support in pneumonia. BMC Pulm Med. 2014 Sep 22;14:149. doi:

10.1186/1471-2466-14-149. PMID: 25244961; PMCID: PMC4189199.

8: Jones JM. Food processing: criteria for dietary guidance and public health?

Proc Nutr Soc. 2019 Feb;78(1):4-18. doi: 10.1017/S0029665118002513. Epub 2018

Sep 25. PMID: 30249309.

9: JONES CRITERIA (modified) for guidance in the diagnosis of rheumatic fever;

report of the Committee on Standards and Criteria for programs of care.

Circulation. 1956 Apr;13(4):617-20. doi: 10.1161/01.cir.13.4.617. PMID:

13356420.

10: Jones R. Think Twice. Br J Gen Pract. 2017 Dec;67(665):539. doi:

10.3399/bjgp17X693521. PMID: 29192096; PMCID: PMC5697526.

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