Jones criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Modified Jones criteria were first published in 1944 by T. Duckett Jones, MD.[1] They have been periodically revised by the American Heart Association in collaboration with other groups.[2] 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 and indolent carditis, each of which by itself can indicate rheumatic fever.[3][4][5]
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. They commonly appear 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. This rash never starts on the face and it is 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.
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Minor criteria
- Fever of 38.2-38.9 C
- Arthralgia: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)
- Raised erythrocyte sedimentation rate or C reactive protein
- Leukocytosis
- ECG showing features of heart block, such as a prolonged PR interval[6] (Cannot be included if carditis is present as a major symptom)
- First Degree AV-Block [7]
- Previous episode of rheumatic fever or inactive heart disease
Other signs and symptoms
- Abdominal pain
- Nose bleeds
- Preceding streptococcal infection: recent scarlet fever, raised antistreptolysin O or other streptococcal antibody titre, or positive throat culture.[7]
- Delirium, stupor, seizures, coma
- Renal failure
- Pulmonary edema
- Ruddiness of the skin secondary to rheumatic vasculitis
- Ruddiness and swelling of the face and neck secondary to jugular system congestion itself secondary to rheumatic carditis and acute, congestive heart failure
- Rheumatic pneumonitis causing a congestive lung condition
References
- ↑ Jones TD (1944). "The diagnosis of rheumatic fever". JAMA. 126: 481–4.
- ↑ 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.
- ↑ Steven J Parrillo, DO, FACOEP, FACEP. "eMedicine — Rheumatic Fever". Retrieved 2007-07-14.
- ↑ "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.
- ↑ 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.
- ↑ Aly, Ashraf (2008). "Rheumatic Fever". Core Concepts of Pediatrics. University of Texas. Retrieved 2011-08-06.
- ↑ 7.0 7.1 Ed Boon, Davidson's General Practice of Medicine, 20th edition. P. 617.