Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography

Abstract

This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.

Rheumatic heart disease and endomyocardial fibrosis: Distinguishing the etiology of mitral regurgitation in low-resourced areas

“…Surgery is technically very demanding, and improvement in knowledge has been slow. Volume 14 Number 1 newest revision of the Jones Criteria (3) allows for echocardiographic evidence of carditis as a major criterion (as opposed to previous iterations allowing only auscultation), and provides less stringent diagnostic requirements for areas considered to be at moderate to high risk, meant to improve the diagnostic sensitivity.…”

Diagnosis of Rheumatic Fever and Rheumatic Heart Disease in Evolution

“…In this continuum, recently, the American Heart Association (AHA) has published her 'Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography'. 10 This Revision of the Jones Criteria has, for the first time, set up separate criteria in accordance with the degree of prevalence of ARF/RHD across the world. Low-risk populations have been defined as are those with ARF incidence <2 per 100,000 school-aged children or allage rheumatic heart disease prevalence of < 1 per 1000 population per year.…”

“…On the other hand, children not clearly from a low-risk population have been considered to be at moderate to high risk depending on their reference population. 10 Like the previous versions, the 'Jones Criteria, 1992 update' includes a number of well-known major and minor criteria. Carditis, arthritis, chorea, subcutaneous nodules and erythema marginatum constitute the major criteria, while minor criteria include fever,arthralgia, raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or leukocytosis, prolonged PR interval on ECG, a previous history of ARF or RHD;diagnosis of first attack of ARF needs presence of either 2 major criteria, or 1 major criterion and 2 minor criteria, along with evidence of preceding group A streptococcal infection.…”

“…11 On the other hand, echocardiography, especially the Doppler modality, is much more efficient in this regard. 10 Therefore, the recent guidelines unequivocally recognize the role of echocardiography in confirmation, follow up and exclusion of the diagnosis of rheumatic carditis. [8][9][10] The 2015 Revision of Jones criteria has advocated that echo with Doppler should be performed in all cases of confirmed and suspected ARF (class I; level of evidence B), and that should be performed to assess whether carditis is present in absence of auscultatory findings, particularly in moderate-to highrisk populations and when ARF is considered likely (class I; level of evidence B).…”

Remember the Jones Criteria?

“…The major and minor criteria have been modified and revised several times since then by a committee of the American Heart Association (AHA)-it has not been updated since 1992 until just a few weeks ago. 2 I was privileged to participate in the recent deliberations as well as the previous Jones Criteria modification in 1992.…”