Diagnostic criteria for the initial attack of acute rheumatic fever (ARF) following Group A Streptococcal (GAS) pharyngitis. The 2015 AHA revised Jones criteria include stricter echocardiographic requirements and risk-stratification based on population rheumatic fever incidence.

Parameters

Prerequisite: Evidence of Preceding Group A Streptococcal Infection

Positive Throat Culture or Rapid Strep TestCurrent or recent positive GAS throat culture or rapid antigen detection test.Elevated or Rising Streptococcal Antibody TitersASO (anti-streptolysin O) > 200 Todd units in adults (> 320 in children), anti-DNase B elevation, or rising titer on serial testing.

Major Jones Criteria

Carditis (Auscultatory or Subclinical Echocardiographic)Clinical carditis: new audible cardiac murmur (mitral regurgitation most common, aortic regurgitation), pericardial rub, cardiomegaly, or heart failure. Subclinical carditis: echocardiographic evidence of mitral or aortic regurgitation meeting strict criteria WITHOUT audible murmur.Polyarthritis (Migratory) or Polyarthralgia (High-Risk Populations Only)Migratory polyarthritis: involvement of ≥ 2 joints sequentially (large joints primarily — knees, ankles, elbows, wrists). Responds dramatically to aspirin within 24–48h. Monoarthritis in high-prevalence populations may be counted under 2015 revised criteria.Sydenham's ChoreaInvoluntary, purposeless, non-rhythmic movements of face and extremities. May occur weeks to months after GAS infection. Does NOT require other criteria or elevated antibodies if clinically unambiguous — Sydenham's chorea alone = ARF.Erythema MarginatumEvanescent, non-pruritic, macular eruption with central clearing and advancing margin. Occurs on trunk and proximal extremities, never face. Comes and goes over hours. Rare (<10% of cases).Subcutaneous NodulesSmall, firm, painless nodules over bony prominences (occiput, wrists, elbows, knees, ankles). Usually associated with severe carditis. Very rare (<1–5%).

Minor Jones Criteria

Fever ≥ 38.5°C (101.3°F)Temperature ≥ 38.5°C at some point during the illness.Elevated ESR or CRPESR ≥ 60 mm/h in low-risk patients (≥ 30 mm in high-risk populations) OR CRP ≥ 3 mg/dL.Prolonged PR Interval on ECGPR interval prolongation above upper limit of normal for age and heart rate. Does not count as minor criterion if carditis is already counted as a major criterion.Arthralgia (Without Polyarthritis as Major Criterion)Arthralgia alone can only be a minor criterion if polyarthritis is NOT already being counted as a major criterion.

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CalculatorsJones Criteria for Rheumatic Fever Diagnosis

Infectious DiseaseCriteria

Jones Criteria for Rheumatic Fever Diagnosis

Diagnostic criteria for the initial attack of acute rheumatic fever (ARF) following Group A Streptococcal (GAS) pharyngitis. The 2015 AHA revised Jones criteria include stricter echocardiographic requirements and risk-stratification based on population rheumatic fever incidence.

Parameters

Prerequisite: Evidence of Preceding Group A Streptococcal Infection

Positive Throat Culture or Rapid Strep TestCurrent or recent positive GAS throat culture or rapid antigen detection test.Elevated or Rising Streptococcal Antibody TitersASO (anti-streptolysin O) > 200 Todd units in adults (> 320 in children), anti-DNase B elevation, or rising titer on serial testing.

Major Jones Criteria

Carditis (Auscultatory or Subclinical Echocardiographic)Clinical carditis: new audible cardiac murmur (mitral regurgitation most common, aortic regurgitation), pericardial rub, cardiomegaly, or heart failure. Subclinical carditis: echocardiographic evidence of mitral or aortic regurgitation meeting strict criteria WITHOUT audible murmur.Polyarthritis (Migratory) or Polyarthralgia (High-Risk Populations Only)Migratory polyarthritis: involvement of ≥ 2 joints sequentially (large joints primarily — knees, ankles, elbows, wrists). Responds dramatically to aspirin within 24–48h. Monoarthritis in high-prevalence populations may be counted under 2015 revised criteria.Sydenham's ChoreaInvoluntary, purposeless, non-rhythmic movements of face and extremities. May occur weeks to months after GAS infection. Does NOT require other criteria or elevated antibodies if clinically unambiguous — Sydenham's chorea alone = ARF.Erythema MarginatumEvanescent, non-pruritic, macular eruption with central clearing and advancing margin. Occurs on trunk and proximal extremities, never face. Comes and goes over hours. Rare (<10% of cases).Subcutaneous NodulesSmall, firm, painless nodules over bony prominences (occiput, wrists, elbows, knees, ankles). Usually associated with severe carditis. Very rare (<1–5%).

Minor Jones Criteria

Fever ≥ 38.5°C (101.3°F)Temperature ≥ 38.5°C at some point during the illness.Elevated ESR or CRPESR ≥ 60 mm/h in low-risk patients (≥ 30 mm in high-risk populations) OR CRP ≥ 3 mg/dL.Prolonged PR Interval on ECGPR interval prolongation above upper limit of normal for age and heart rate. Does not count as minor criterion if carditis is already counted as a major criterion.Arthralgia (Without Polyarthritis as Major Criterion)Arthralgia alone can only be a minor criterion if polyarthritis is NOT already being counted as a major criterion.

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