Jones criteria for acute rheumatic fever (AHA 2015 revision)

What are the Jones criteria?

Acute rheumatic fever is an inflammatory illness that can follow a throat infection with group A streptococcus (strep). It can affect the heart, joints, brain and skin. The Jones criteria are a set of rules for when the features seen in a patient fit acute rheumatic fever. This page is about those criteria, not the Jones fracture of the foot.

The rules sort findings into major and minor manifestations. Evidence of a preceding strep infection is required in every case. Then either enough majors, or a mix of majors and minors, must be present. For a recurrent episode, three minors can also be enough.

The 2015 revision split the rules by population risk, because rheumatic fever is far more common in some places than others. Magent's calculator takes the episode type, the population risk and each finding as entered, and returns the major count, the minor count and whether the Jones criteria are met.

This page explains the rules. It doesn't say what a result means for a particular person.

The Jones criteria rules

required in every case:   evidence of preceding group A strep infection

first (initial) episode:  2 majors, or 1 major + 2 minors
recurrent episode:        2 majors, or 1 major + 2 minors, or 3 minors

majors                    low risk                  moderate-to-high risk
carditis                  yes                       yes
joints                    polyarthritis             polyarthritis or monoarthritis,
                                                    else polyarthralgia
chorea                    yes                       yes
erythema marginatum       yes                       yes
subcutaneous nodules      yes                       yes

minors                    low risk                  moderate-to-high risk
joints                    polyarthralgia            monoarthralgia
                          (if no joint major)       (if no joint major)
fever                     ≥ 38.5 °C                 ≥ 38 °C
ESR or CRP                ESR ≥ 60 mm/h or          ESR ≥ 30 mm/h or
                          CRP ≥ 3.0 mg/dL           CRP ≥ 3.0 mg/dL
prolonged PR interval     counted when there is no carditis

Exact expression the calculator uses:

jones_arf iff evidence_of_preceding_gas and episode rule (Gewitz 2015 Table 7). initial: 2 major or (1 major and 2 minor). recurrent: 2 major or (1 major and 2 minor) or 3 minor. Majors: carditis (clinical and/or subclinical); arthritis (low: polyarthritis; moderate_high: polyarthritis or monoarthritis, else polyarthralgia); chorea; erythema_marginatum; subcutaneous_nodules. Minors: polyarthralgia (low, if no arthritis major); monoarthralgia (moderate_high, if no arthritis or polyarthralgia major); fever (low: fever_ge_38_5; moderate_high: fever_ge_38); ESR/CRP (low: esr_ge_60_or_crp_ge_3; moderate_high: esr_ge_30_or_crp_ge_3); prolonged_pr only when carditis is false. Joints count in major or minor, not both, at most one joint major. Not Jones 1944. Not a diagnosis

Inputs

All inputs are required. A low-risk population is one with acute rheumatic fever incidence of 2 or fewer per 100000 school-aged children, or rheumatic heart disease prevalence of 1 or fewer per 1000 at all ages. The user decides which applies.

How the calculation works

1. Check for evidence of a preceding strep infection. Without it, the criteria aren't met whatever else is present.
2. Count the majors. Carditis, chorea, erythema marginatum and subcutaneous nodules each count once. At most one joint finding counts as a major, using the rule for the population risk.
3. Count the minors. Use the fever and ESR/CRP inputs for the population risk. A joint finding counts as a minor when no joint major was counted. A prolonged PR interval counts when carditis is false.
4. Apply the episode rule. First episode: 2 majors, or 1 major and 2 minors. Recurrent episode: the same, or 3 minors.

Each joint finding counts as a major or a minor, never both. Inputs for the other population risk are ignored, so a low-risk fever of 38 °C that is below 38.5 °C doesn't count.

Units

All inputs are categories or true/false flags. The temperature, ESR and CRP thresholds are written into the input names: fever in °C, ESR in mm/h and CRP in mg/dL. The calculator doesn't take the measured values themselves.

Worked examples

These use Magent's own expected values for the calculator.

History of the 2015 Jones criteria

Limits of the calculation

How it differs from related calculators

• Kawasaki disease criteria count days of fever and five principal features. The Jones criteria count majors and minors after strep.
• Centor and McIsaac scores add points for features of a sore throat. The Jones criteria deal with what may follow a strep infection.

Glossary

• Group A streptococcus (GAS): the bacterium that causes strep throat.
• Carditis: inflammation of the heart. Subclinical carditis is seen on echocardiography without signs on examination.
• Polyarthritis and monoarthritis: joint inflammation in several joints or in one.
• Polyarthralgia and monoarthralgia: joint pain without inflammation in several joints or in one.
• Sydenham chorea: involuntary jerky movements.
• ESR and CRP: blood tests that rise with inflammation.
• PR interval: a measurement on the ECG.

Common mistakes

• Forgetting the strep requirement. Without evidence of preceding strep, the criteria are never met.
• Counting two joint majors. At most one joint finding counts as a major.
• Using the wrong fever or ESR threshold. Low risk uses 38.5 °C and ESR 60. Moderate-to-high risk uses 38 °C and ESR 30.
• Counting a prolonged PR interval alongside carditis. It counts as a minor when carditis is absent.
• Applying the 3-minor rule to a first episode. It applies to recurrent episodes.

Source

Frequently asked questions

Related

• Infection and VTE calculators
• Kawasaki disease criteria
• Centor and McIsaac scores
• All calculator explainers