Rheumatic Fever
(Acute Rheumatic Fever or ARF)

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Medical Author: David Perlstein, MD, FAAP
Medical Editor: Charles Davis, MD, PhD

• What is rheumatic fever?
• What are the Jones criteria?
• What causes rheumatic fever?
• What are symptoms and signs of rheumatic fever?
• How is rheumatic fever diagnosed?
• How is rheumatic fever treated?
• What are the complications of rheumatic fever?
• How is rheumatic fever prevented?
• How common is rheumatic fever?
• Where can one find more information on rheumatic fever?
• Rheumatic Fever (Acute Rheumatic Fever or ARF) At A Glance

What is rheumatic fever?

Rheumatic fever (acute rheumatic fever or ARF) is an autoimmune disease that may occur after a group A streptococcal throat infection that causes inflammatory lesions in connective tissue, especially that of the heart, joints, blood vessels, and subcutaneous tissue. The disease has been described since the 1500s, but the association between a throat infection and rheumatic fever symptom development was not described until the 1880s. It was associated with scarlet fever (rash caused by streptococcal exotoxins) in the 1900s. Prior to the broad availability of penicillin, rheumatic fever was a leading cause of death in children and one of the leading causes of acquired heart disease in adults. The disease has many symptoms and can affect different parts of the body, including the heart, joints, skin, and brain. There is no simple diagnostic test for rheumatic fever, so the American Heart Association's modified Jones criteria (first published in 1944 and listed below) are used to assist the physician in making the proper diagnosis.

What are the Jones criteria?

Jones criteria are guidelines decided on by the American Heart Association to help doctors clinically diagnose rheumatic fever. Two major criteria or one major and two minor plus a history of a streptococcal throat infection are required to make the diagnosis of rheumatic fever.

The major criteria for diagnosis include

• arthritis in several joints (polyarthritis),



• heart inflammation (carditis),



• nodules under the skin (subcutaneous nodules or Aschoff bodies),



• rapid, jerky movements (Sydenham's chorea), and



• skin rash (erythema marginatum).

The minor criteria include

• fever,



• high ESR (erythrocyte sedimentation rate, an laboratory sign of inflammation),



• joint pain (arthralgia),



• EKG changes (electrocardiogram), and



• other laboratory findings (elevated C-reactive protein, elevated or rising streptococcal antigen test).

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