Jones criteria for the diagnosis of acute rheumatic fever was first published in 1944 [Jones TD. The diagnosis of rheumatic fever. J Am Med Assoc. 1944;126(8):481-484]. Major manifestations described in this paper were carditis, arthralgia, chorea, subcutaneous nodules and recurrences of rheumatic fever. Minor manifestations were fever, abdominal pain, precordial pain, rashes, epistaxis, pulmonary findings and laboratory findings. The diagnosis of rheumatic fever was considered reasonable if there was: 1) Any combination of major manifestations 2) Combination of one major and two minor manifestations 3) Minor manifestations alone, in the presence of rheumatic heart disease, when other causes can be excluded.
Over the years, the original Jones criteria for the diagnosis of rheumatic fever have been revised and modified several times. The 1992 update was by a special writing group headed by Dajani AS et al [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 (1992) Guidelines for the diagnosis of acute rheumatic fever: Jones criteria, 1992 update. JAMA 268:2069–2073]. According to the 1992 update, the major manifestations were carditis, polyarthritis, chorea, erythema marglnatum and subcutaneous nodules. The minor manifestations were grouped into clinical findings and laboratory findings. The clinical findings were arthralgia and fever. The laboratory findings were elevated acute phase reactants (erythrocyte sedimentation rate, C-reactive protein) and prolonged PR Interval. In addition supporting evidence of antecedent Group A streptococcal infection were included as postive throat culture or rapid streptococcal antigen test and elevated or rising streptococcal antibody liter. The presence of two major manifestations or of one major and two minor manifestations indicates a high probability of acute rheumatic fever, if there is evidence of a preceding group A streptococcal infection.
In 2000 another working group chaired by Patricia Ferrieri was set up by the American Heart Association, to see whether further revision was required. The report was published in: Circulation. 2002;106:2521-2523. They were of the opinion that there was no need to revise the criteria for the diagnosis of first episode of rheumatic fever. They also concluded that although echocardiography was useful in the evaluation of rheumatic heart disease, the evidence did not favour including echocardiographic findings as major or minor diagnostic criteria.