Version July 2025
| |
| 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 |
| |
| Low-risk populations* | Moderate- and high-risk populations |
Carditis¶
| Carditis
|
Arthritis
| Arthritis
|
| Chorea | Chorea |
| Erythema marginatum | Erythema marginatum |
| Subcutaneous nodules | Subcutaneous nodules |
| |
| 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) |
ARF: acute rheumatic fever; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GAS: group A streptococcal infection.
* 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 Refer to 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 the criteria, 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.
