The Jones criteria were introduced in 1944 as a set of clinical guidelines for the diagnosis of RHF. They have subsequently undergone significant modifications ,the final ones published in  2002.

These revised WHO criteria speak to the diagnosis of :

  a primary episode of RF

  recurrent attacks of RF in patients without RHD

  recurrent attacks of RF with RHD

  rheumatic chorea

  insidious onset rheumatic carditis

  chronic RHD

It is important to note that in the context of a preceding streptococcal infection, 2 major criteria, or a combination of one major and 2 minor, provide reasonable evidence for a diagnosis of RF.

Major criteria: carditis, arthritis, chorea, subcutaneous nodules, erythema marginatum.

Minor criteria:

Clinical: fever, polyarthralgia

Lab: elevated acute phase reactants ESR/CRP

This little cartoon character demonstrates the features of acute rheumatic fever.

Chorea (St Vitus dance)

Flitting polyarthritis- it is important to be aware that monoarthritis is an important presenting complaint in patients from developing countries WEBLINK

Erythema marginatum and subcutaneous nodules are the dermatological manifestations of ARF.

The only manifestation of ARF with potentially life-threatening and permanent sequelae is the carditis- as evident either as valvulitis( the precursor to rheumatic heart disease) pericarditis and myocarditis.ie a pancarditis.

Histologically Aschoff nodules is the hallmark pathognomonic feature and on special investigations the minor criteria such as high ESR or CRP is noted. Evidence of previous infection with GAS either via ASOT/anti-DNAse B titres or with precious evidence of streptococcus being cultured from the throat is an important adjunct to this diagnosis.

Currently carditis as diagnosed by echo alone is not included in the major criteria despite repeated calls for its inclusion. It is currently recommended that all patients with the clinical diagnosis of ARF even those without clinical evidence of carditis be referred for an echocardiogram( if available)