## Revised Jones Criteria (2015) for Acute Rheumatic Fever **Key Point:** The 2015 revised Jones criteria distinguish between **initial ARF** (no prior ARF/RHD) and **recurrent ARF** (prior ARF/RHD). ESR is a **minor criterion**, not a major criterion. ### Major Criteria (Initial ARF — No Prior History) Remember the mnemonic **JONES**: **Mnemonic:** **J**oint inflammation, **O**rgan involvement (carditis), **N**odules (subcutaneous), **E**rythema marginatum, **S**ydenham chorea | Major Criterion | Features | |-----------------|----------| | **Carditis** | Clinical and/or subclinical (echo) | | **Polyarthritis** | Migratory, large joints (knees, ankles, elbows, wrists) | | **Chorea** | Involuntary movements, emotional lability, muscle weakness | | **Erythema marginatum** | Non-pruritic, pink macules with pale centers, trunk/proximal limbs | | **Subcutaneous nodules** | Firm, painless, over bony prominences | ### Minor Criteria - Polyarthralgia (in low-risk populations) - Fever ≥38.5°C - **Elevated ESR** (≥60 mm/h) and/or **elevated CRP** (≥3.0 mg/dL) - Leukocytosis **High-Yield:** ESR and CRP are **minor criteria** for inflammation, NOT major diagnostic criteria. They support the diagnosis but are non-specific. ### Diagnosis of Initial ARF **2 major criteria** OR **1 major + 2 minor criteria** + evidence of preceding GAS infection (throat culture, rapid antigen test, elevated/rising anti-streptococcal antibody titer). **Warning:** Do not confuse ESR/CRP (minor criteria, markers of inflammation) with the cardinal clinical features (major criteria). ESR elevation is common in many conditions and is used to support diagnosis, not define it. **Clinical Pearl:** Subcutaneous nodules and erythema marginatum are rare manifestations (seen in <5% of cases) but are highly specific for ARF when present — they are "major" because of their specificity, not frequency. 
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