2025 – PAGE 136 – CARDIOLOGY

MINOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER

Minor Jones criteria for acute rheumatic fever include:

• ARTHRALGIAS: Refers to PAIN without inflammation. Note that this is a MINOR criterion.
• Elevated ESR or CRP
• Fever
• Prolonged PR

Note that joint criteria can only be used once, so you cannot use arthritis as a major criterion and also use arthralgia as a minor criterion.

MNEMONIC for the MAJOR JONES CRITERIA: J O N E S

• Joints: asymmetric, migratory, polyarthritis of the large joints (ankles, knees, wrists)
• O looks like a HEART (): Carditis = new murmurs, CHF, cardiomegaly and pericarditis.
• Nodules: Painless and firm subcutaneous nodules (wrists, elbows, knees)
• Erythema MARGINatum: The name MARGINatum should remind you of the interesting facts regarding the MARGINs of the rash.
• Sydenham’s Chorea: Movements of the face and/or extremities without purpose and sometimes described as “purposeless dancing.”

PEARLS: 

• Rheumatic fever is almost always due by Group A Streptococcal PHARYNGITIS. Rarely, though, it may be caused by Scarlet fever. It is not associated with skin infections.
• EXCEPTIONS to JONES Criteria:
  • CHOREA alone, in the context of a recent Strep infection, may be diagnostic.
  • So-called “indolent” carditis, i.e. not acute, may be the only manifestation months after a Strep infection.

RHEUMATIC FEVER TREATMENT

For treatment of rheumatic fever, use Penicillin VK (oral) x 10 days or Benzathine Penicillin (IM/IV) x 1. If the patient has evidence of carditis, also give Aspirin (ASA) and prednisone.

• RECURRENCE: Since there is a high chance of recurrence, administer monthly injections of penicillin to prevent Group A Streptococcal pharyngitis. This may be discontinued after 21 years of age.

RHEUMATIC FEVER ASSOCIATIONS

• ASCHOFF BODIES are nodules on the heart or in the aorta. They are pathognomonic for Acute Rheumatic Fever. Biopsy reveals inflammatory cells arranged in a “ROSETTE” pattern around a fibrinoid core.
• Mitral, tricuspid, and aortic valves can be affected. Lesions can be stenotic or due to regurgitation. Mitral stenosis and tricuspid stenosis are frequently due to rheumatic fever. Mitral regurgitation is the most common murmur of rheumatic fever. Possible descriptions might include the harsh, systolic, apical murmur of mitral regurgitation, or the apical diastolic murmur of aortic regurgitation (so look for evidence of CHF).
• Endocarditis occurs due to destruction of valves, NOT infection.
• Emotional lability is another associated finding in RF.