Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever

Evidence of preceding GAS infection (≥1 of the following)

Increased or rising anti-streptolysin O titer or other streptococcal antibodies (anti-DNASE B). A rise in titer is better evidence than single titer result.

A positive thoat culture for group A beta-hemolytic streptococci.

A positive rapid group A streptococcal carbohydrate antigen test in a child whose clinical presentation suggests a high pretest probability of streptococcal pharyngitis

History of ARF or established rheumatic heart disease

Yes

No

History of ARF or established rheumatic heart disease

Low risk population: an ARF incidence <2 per 100,000 school-aged children per year or an all-age prevalence of RHD of ≤ 1 per 1000 population per year

Moderate-risk and High-risk population

Minor criteria

Polyarthralgia

Fever (≥ 38.5 C)

ESR ≥ 60 mm in the first hour and/or CRP ≥ 3.0 mg/dL

Prolonged PR interval, after accounting for age variability (unless carditis is a major criterion)

Major criteria

Minor criteria

Monoarthralgia

Fever (≥ 38 C)

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)

Result

Findings in Rheumatic Valvulitis

Doppler Findings in Rheumatic Valvulitis

Pathological mitral regurgitation (all 4 criteria met)

Seen in at least 2 views
Jet length ≥2 cm in at least 1 view
Peak velocity >3 m/s
Pansystolic jet in at least 1 envelope

Pathological aortic regurgitation (all 4 criteria met)

Seen in at least 2 views
Jet length ≥1 cm in at least 1 view
Peak velocity >3 m/s
Pan diastolic jet in at least 1 envelope

Morphological Findings on Echocardiogram in Rheumatic Valvulitis

Acute mitral valve changes

Annular dilation
Chordal elongation
Chordal rupture resulting in flail leaflet with severe mitral regurgitation
Anterior (or less commonly posterior) leaflet tip prolapse
Beading/nodularity of leaflet tips

Chronic mitral valve changes: not seen in acute carditis

Leaflet thickening
Chordal thickening and fusion
Restricted leaflet motion
Calcification

Aortic valve changes in either acute or chronic carditis

Irregular or focal leaflet thickening
Coaptation defect
Restricted leaflet motion
Leaflet prolapse

References

Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, et al. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. Circulation [Internet]. 2015 May 19 [cited 2025 Oct 2];131(20):1806–18. Available from: https://doi.org/10.1161/CIR.0000000000000205