Jones criteria for rheumatic fever – 2015 revision

Jones criteria for rheumatic fever – 2015 revision

Jones criteria were originally proposed in 1944 and revised / modified several times, with the last one by the American Heart Association (AHA) in 1992 [1]. In all these criteria, echocardiography has not been given a role in the diagnosis of carditis, which was principally a clinical diagnosis. Since then echocardiography has become widely available and several papers documenting utility of earlier diagnosis of subclinical carditis by echocardiography have been published. Taking all these evidence in context, the American Heart Association has revised the Jones criteria in 2015 [2].

The salient difference between the older criteria, is of course, the inclusion of echocardiography for diagnosis of subclinical carditis. They have suggested specific echocardiographic criteria for diagnosing rheumatic valvular regurgitation of the mitral and aortic valves. In case of rheumatic mitral valve prolapse, it may be noted that only the leaflet tip will bend into the left atrium, unlike the body of the valve leaflet in classical mitral valve prolapse.

Another important highlight is inclusion of monoarthritis and polyarthralgia as potential major criteria in populations with moderate to high risk of rheumatic fever. Low grade fever has also been included in the minor criteria in such populations. For diagnosis of recurrence of rheumatic activity, even three minor criteria, without any major criteria can also be considered.

An appraisal of the revised criteria from the Indian perspective has also been published calling Pediatricians and Cardiologists in India to formulate their own guidelines adding Doppler echocardiography to the list of diagnostic tests [3].

Reference

1. Dajani AS, Ayoub E, Bierman FZ, Bisno AL, Denny FW, Durack DT, Ferrieri P, Freed M, Gerber M, Kaplan EL, Karchmer AW, Markowitz M, Rahimtoola SH, Shulman ST, Stollerman G, Takahashi M, Taranta A, Taubert KA, Wilson W. Guidelines for the diagnosis of rheumatic fever: Jones criteria, 1992 update. JAMA. 1992;268:2069–2073.
2. Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, Remenyi B, Taubert KA, Bolger AF, Beerman L, Mayosi BM, Beaton A, Pandian NG, Kaplan EL; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography: A Scientific Statement From the American Heart Association. Circulation. 2015; 131: 1806-1818.
3. Sahasranam KV. Revised Jones Criteria For The Diagnosis of Acute Rheumatic Fever (AHA 2015) – An Indian Perspective. BMH Medical Journal 2015;2(3):57-59.