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{{Rheumatic fever}}
{{Rheumatic fever}}
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==Overview==
The Jones criteria can be used to establish the diagnosis of rheumatic fever. They were first published in 1944 by T. Duckett Jones, MD and have been periodically revised by the [[American Heart Association]] in collaboration with other groups.<ref name=":0">{{cite journal |author=Jones TD |title=The diagnosis of rheumatic fever. |journal=[[Journal of the American Medical Association|JAMA]] |volume=126 |issue= |pages=481–4 |year=1944 |pmid= |doi= |url=}}</ref><ref name=":1">{{cite journal |author=Ferrieri P |title=Proceedings of the Jones Criteria workshop |journal=Circulation |volume=106 |issue=19 |pages=2521–3 |year=2002 |pmid=12417554 |doi= 10.1161/01.CIR.0000037745.65929.FA|url=http://circ.ahajournals.org/cgi/content/full/106/19/2521?ck=nck |last2=Jones Criteria Working |first2=Group}}</ref>
 
==Jones Criteria for the Diagnosis of Rheumatic Fever==
===Criteria for Definitive Rheumatic Fever===
The Jones Criteria for definitive rheumatic fever require evidence of streptococcal infection: elevated or rising [[antistreptolysin O titre]] or DNAase and either:
*Two major criteria
<u>'''OR'''</u>
*One major and two minor criteria
 
Exceptions are [[chorea (disease)|chorea]] and indolent [[carditis]], each of which by itself can indicate rheumatic fever.<ref>{{cite web |url=http://www.emedicine.com/emerg/topic509.htm |title=eMedicine — Rheumatic Fever | author = Steven J Parrillo, DO, FACOEP, FACEP |accessdate=2007-07-14 |work=}}</ref><ref>{{cite journal |author= |title=Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association |journal=JAMA |volume=268 |issue=15 |pages=2069–73 |year=1992 |pmid=1404745 |doi=10.1001/jama.268.15.2069}}</ref><ref>{{cite journal|first=Anita|last=Saxena|title=Diagnosis of rheumatic fever: Current status of Jones criteria and role of echocardiography|journal=Indian Journal of Pediatrics|volume=67|issue=4|pages=283–6|year=2000|pmid=11129913|doi=10.1007/BF02758174}}</ref><ref name=":0" /><ref name=":1" />


==Overview==
===Criteria for the Rejection of Rheumatic Fever===
[[Image:Rheumatic heart disease, gross pathology 20G0013 lores.jpg|thumb|right|Rheumatic heart disease at [[autopsy]] with characteristic findings (thickened [[mitral valve]], thickened [[chordae tendineae]], hypertrophied left ventricular [[myocardium]]).]]
*Firm alternate diagnosis to rheumatic fever
Modified Jones criteria were first published in 1944 by T. Duckett Jones, MD.<ref>{{cite journal |author=Jones TD |title=The diagnosis of rheumatic fever. |journal=[[Journal of the American Medical Association|JAMA]] |volume=126 |issue= |pages=481–4 |year=1944 |pmid= |doi= |url=}}</ref> They have been periodically revised by the [[American Heart Association]] in collaboration with other groups.<ref>{{cite journal |author=Ferrieri P |title=Proceedings of the Jones Criteria workshop |journal=Circulation |volume=106 |issue=19 |pages=2521–3 |year=2002 |pmid=12417554 |doi= 10.1161/01.CIR.0000037745.65929.FA|url=http://circ.ahajournals.org/cgi/content/full/106/19/2521?ck=nck |last2=Jones Criteria Working |first2=Group}}</ref> According to revised Jones criteria, the diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection: elevated or rising [[antistreptolysin O titre]] or DNAase. Exceptions are [[chorea (disease)|chorea]] and [[indolent carditis]], each of which by itself can indicate rheumatic fever.<ref>{{cite web |url=http://www.emedicine.com/emerg/topic509.htm |title=eMedicine — Rheumatic Fever | author = Steven J Parrillo, DO, FACOEP, FACEP |accessdate=2007-07-14 |work=}}</ref><ref>{{cite journal |author= |title=Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association |journal=JAMA |volume=268 |issue=15 |pages=2069–73 |year=1992 |pmid=1404745 |doi=10.1001/jama.268.15.2069}}</ref><ref>{{cite journal|first=Anita|last=Saxena|title=Diagnosis of rheumatic fever: Current status of Jones criteria and role of echocardiography|journal=Indian Journal of Pediatrics|volume=67|issue=4|pages=283–6|year=2000|pmid=11129913|doi=10.1007/BF02758174}}</ref>
*Does not meet criteria below


===Major criteria===
===Major criteria===
*[[Arthritis|Polyarthritis]]: a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
*[[Arthritis|Polyarthritis]]: a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards
*[[Carditis]]: inflammation of the heart muscle which can manifest as [[congestive heart failure]] with shortness of breath, [[pericarditis]] with a rub, or a new [[heart murmur]].
*[[Carditis]]: inflammation of the heart muscle which can manifest as [[congestive heart failure]] with shortness of breath, [[pericarditis]] with a rub, or a new [[heart murmur]]
*Subcutaneous nodules: painless, firm collections of collagen fibers over bones or [[tendons]]. They commonly appear on the back of the wrist, the outside elbow, and the front of the knees.
*Subcutaneous nodules: painless, firm collections of collagen fibers over bones or [[tendon]]s, commonly presenting on the back of the wrist, the outside elbow, and the front of the knees
*[[Erythema marginatum]]: a long lasting [[rash]] that begins on the trunk or arms as [[macule]]s and spreads outward to form a snake like ring while clearing in the middle. This rash never starts on the face and it is made worse with heat.
*[[Erythema marginatum]]: a long lasting [[rash]] that begins on the trunk or arms as [[macule]]s and spreads outward to form a snake like ring while clearing in the middle, made worse with heat
*[[Sydenham's chorea]] (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease for at least three months from onset of infection.
*[[Sydenham's chorea]] (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms, occurring late in the disease for at least three months from the onset


===Minor criteria===
[[Image:Erythema marginatum 1.jpg|Erythema Marginatum]]
*[[Fever]] of 38.2-38.9 C
{{#ev:youtube|RsIQFeYOkAg}}
<br clear:"left"/>
 
===Minor criteria:<ref name=":2" /><ref name="davidson617" /><ref name="pmid22868672">{{cite journal |vauthors=Balli S, Oflaz MB, Kibar AE, Ece I |title=Rhythm and conduction analysis of patients with acute rheumatic fever |journal=Pediatr Cardiol |volume=34 |issue=2 |pages=383–9 |date=February 2013 |pmid=22868672 |doi=10.1007/s00246-012-0467-5 |url=}}</ref>===
*[[Fever]] of 100-102°F (38.2-38.9°C)
*[[Arthralgia]]: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)
*[[Arthralgia]]: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)
*Raised [[erythrocyte sedimentation rate]] or [[C reactive protein]]
*Raised [[erythrocyte sedimentation rate]] or [[C reactive protein]]
*[[Leukocytosis]]
*[[Leukocytosis]]
*[[Electrocardiogram|ECG]] showing features of [[heart block]], such as a prolonged [[PR interval]]<ref> {{cite web | url = http://www.utmb.edu/pedi_ed/CORE/Cardiology/page_40.htm | title = Rheumatic Fever | accessdate = 2011-08-06 | last = Aly | first = Ashraf | date = 2008 | work = Core Concepts of Pediatrics | publisher = University of Texas}}</ref> (Cannot be included if carditis is present as a major symptom)
*[[Electrocardiogram|ECG]] showing features of [[heart block]], such as a prolonged [[PR interval]]<ref name=":2"> {{cite web | url = http://www.utmb.edu/pedi_ed/CORE/Cardiology/page_40.htm | title = Rheumatic Fever | accessdate = 2011-08-06 | last = Aly | first = Ashraf | date = 2008 | work = Core Concepts of Pediatrics | publisher = University of Texas}}</ref> (Cannot be included if carditis is present as a major symptom)
* First Degree AV-Block <ref name="davidson617">Ed Boon, Davidson's General Practice of Medicine, 20th edition. P. 617.</ref>
*[[First degree AV block]]<ref name="davidson617">Ed Boon, Davidson's General Practice of Medicine, 20th edition. P. 617.</ref>
*Previous episode of rheumatic fever or inactive heart disease
*Previous episode of rheumatic fever or inactive [[heart disease]]
 
===Other signs and symptoms===
*[[Abdominal pain]]
*[[Epistaxis|Nose bleeds]]
*Preceding streptococcal infection: recent scarlet fever, raised antistreptolysin 0 or other streptococcal antibody titre, or positive throat culture.<ref name="davidson617"/>


==References==
==References==
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Infectious disease]]
[[Category:Rheumatology]]
[[Category:Overview complete]]
 
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Overview

The Jones criteria can be used to establish the diagnosis of rheumatic fever. They were first published in 1944 by T. Duckett Jones, MD and have been periodically revised by the American Heart Association in collaboration with other groups.[1][2]

Jones Criteria for the Diagnosis of Rheumatic Fever

Criteria for Definitive Rheumatic Fever

The Jones Criteria for definitive rheumatic fever require evidence of streptococcal infection: elevated or rising antistreptolysin O titre or DNAase and either:

  • Two major criteria

OR

  • One major and two minor criteria

Exceptions are chorea and indolent carditis, each of which by itself can indicate rheumatic fever.[3][4][5][1][2]

Criteria for the Rejection of Rheumatic Fever

  • Firm alternate diagnosis to rheumatic fever
  • Does not meet criteria below

Major criteria

  • Polyarthritis: a temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards
  • Carditis: inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur
  • Subcutaneous nodules: painless, firm collections of collagen fibers over bones or tendons, commonly presenting on the back of the wrist, the outside elbow, and the front of the knees
  • Erythema marginatum: a long lasting rash that begins on the trunk or arms as macules and spreads outward to form a snake like ring while clearing in the middle, made worse with heat
  • Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movements without purpose of the face and arms, occurring late in the disease for at least three months from the onset

Erythema Marginatum {{#ev:youtube|RsIQFeYOkAg}}

Minor criteria:[6][7][8]

References

  1. 1.0 1.1 Jones TD (1944). "The diagnosis of rheumatic fever". JAMA. 126: 481–4.
  2. 2.0 2.1 Ferrieri P; Jones Criteria Working, Group (2002). "Proceedings of the Jones Criteria workshop". Circulation. 106 (19): 2521–3. doi:10.1161/01.CIR.0000037745.65929.FA. PMID 12417554.
  3. Steven J Parrillo, DO, FACOEP, FACEP. "eMedicine — Rheumatic Fever". Retrieved 2007-07-14.
  4. "Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association". JAMA. 268 (15): 2069–73. 1992. doi:10.1001/jama.268.15.2069. PMID 1404745.
  5. Saxena, Anita (2000). "Diagnosis of rheumatic fever: Current status of Jones criteria and role of echocardiography". Indian Journal of Pediatrics. 67 (4): 283–6. doi:10.1007/BF02758174. PMID 11129913.
  6. 6.0 6.1 Aly, Ashraf (2008). "Rheumatic Fever". Core Concepts of Pediatrics. University of Texas. Retrieved 2011-08-06.
  7. 7.0 7.1 Ed Boon, Davidson's General Practice of Medicine, 20th edition. P. 617.
  8. Balli S, Oflaz MB, Kibar AE, Ece I (February 2013). "Rhythm and conduction analysis of patients with acute rheumatic fever". Pediatr Cardiol. 34 (2): 383–9. doi:10.1007/s00246-012-0467-5. PMID 22868672.