Page 145 - Clinical Pearls in Cardiology

Heart Disease and Fever 133

8. What is the importance of modified Jones criteria in
rheumatic fever?
The modified Jones criteria provide guidelines for

making the diagnosis of rheumatic fever. The Jones
criteria require the presence of either 2 major or 1 major
and 2 minor criteria for making a diagnosis of rheumatic
fever. In addition, there should be evidence of preceding
group A streptococcal pharyngitis, which is considered
as the essential criteria. The Jones criteria include the
following, of which, the last four are classified as the
minor criteria.
1. Carditis (usually pancarditis and the mitral valve is
affected in more than 90% of the cases, followed by
the aortic valve).
2. Polyarthritis (usually asymmetric migratory or
fleeting large joint arthritis with dramatic response
to aspirin, and it is the most common major
manifestation).
3. Chorea (late manifestation occurring at least three
months after the episode of acute rheumatic fever,
and it is more common in females).
4. Subcutaneous nodules (small, firm and painless
nodules over the extensor surfaces of bones or
tendons).
5. Erythema marginatum (red macules with pale center
over the trunk and proximal extremities).
6. Fever.
7. Arthralgia.
8. Prolonged PR interval on electrocardiography.
9. Elevated acute-phase reactants (ESR and CRP levels).
Evidence of preceding streptococcal pharyngitis
(either one of the following must be present): Positive
throat culture or rapid streptococcal antigen test or