- Used to diagnose acute rheumatic fever
Criteria
| Low-risk populations | Moderate- and high-risk populations |
|---|---|
| Major criteria | |
| Carditis (clinical or subclinical) | Carditis (clinical or subclinical) |
| Arthritis (polyarthritis) | Arthritis (monoarthritis, polyarthritis, or polyarthralgia) |
| Chorea | Chorea |
| Erythema marginatum | Erythema marginatum |
| Subcutaneous nodules | Subcutaneous nodules |
| Minor criteria | |
| Polyarthralgia (without arthritis) | Monoarthralgia (without arthritis) |
| Fever ≥38.5ºC | Fever ≥38ºC |
| ESR ≥60 mm/h or CRP ≥3 mg/dL | ESR ≥30 mm/h or CRP ≥3 mg/dL |
| Prolonged PR interval (without carditis) | Prolonged PR interval (without carditis) |
- Low-risk = ≤2 cases of acute rheumatic fever per 100,000 school-aged children, or ≤1 case of rheumatic heart disease per 1000 people of any age
Major criteria
- Polyarthritis: A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
- Carditis: Inflammation of the heart muscle (myocarditis) which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur. This includes subclinical carditis suggested by valvulitis on echo.
- Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons. They commonly appear on the back of the wrist, the outside elbow, and the front of the knees.
- Erythema marginatum: A long-lasting reddish rash that begins on the trunk or arms as macules, which spread outward and clear in the middle to form rings, which continue to spread and coalesce with other rings, ultimately taking on a snake-like appearance. This rash typically spares the face and is made worse with heat.
- Sydenham's chorea (St. Vitus' dance): A characteristic series of involuntary rapid movements of the face and arms. This can occur very late in the disease for at least three months from onset of infection.
Minor criteria
- Fever
- Arthralgia: joint pain without swelling (cannot be included if arthritis is present as a major symptom)
- Raised erythrocyte sedimentation rate or C reactive protein
- ECG showing features of heart block, such as a prolonged PR interval (cannot be included if carditis is present as a major symptom)
Interpretation
- Two of the major criteria
- One major criterion plus two minor criteria
