Revised Jones criteria

A. For all patient populations with evidence of preceding GAS infection
Diagnosis: initial ARF	2 Major manifestations or 1 major plus 2 minor manifestations
Diagnosis: recurrent ARF	2 Major or 1 major and 2 minor or 3 minor
B. Major criteria
Low-risk populations*	Moderate- and high-risk populations
Carditis^¶	Carditis
Clinical and/or subclinical	Clinical and/or subclinical
Arthritis	Arthritis
Polyarthritis only	Monoarthritis or polyarthritis Polyarthralgia^Δ
Chorea	Chorea
Erythema marginatum	Erythema marginatum
Subcutaneous nodules	Subcutaneous nodules
C. Minor criteria
Low-risk populations*	Moderate- and high-risk populations
Polyarthralgia	Monoarthralgia
Fever (≥38.5°C)	Fever (≥38°C)
ESR ≥60 mm in the first hour and/or CRP ≥3.0 mg/dL^◊	ESR ≥30 mm/h and/or CRP ≥3.0 mg/dL^◊
Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)	Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)

Evidence of preceding GAS infection is required for both populations.

GAS: group A streptococcal infection; ARF: acute rheumatic fever; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein.
* Low-risk populations are those with ARF incidence ≤2 per 100,000 school-aged children or all-age rheumatic heart disease prevalence of ≤1 per 1000 population-year.
¶ Subclinical carditis indicates echocardiographic valvulitis.
Δ See section on polyarthralgia, which should only be considered as a major manifestation in moderate- to high-risk populations after exclusion of other causes. As in past versions of he criterial, erythema marginatum and subcutaneous nodules are rarely "stand alone" major criteria. Additionally, joint manifestations can only be considered in either the major or minor categories but not both in the same patient.
◊ CRP value must be greater than upper limit of normal for laboratory. Also, because ESR may evolve during the course of ARF, peak ESR values should be used.

Graphic 109550 Version 8.0

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Revised Jones criteria