Jones criteria and underdiagnosis of rheumatic fever.
OBJECTIVE
The authors attempt to determine whether typical clinical and laboratory manifestations of acute rheumatic fever (ARF) are in accordance to what has been traditionally described and how useful the Jones criteria are for diagnosis.


METHODS
Data from 81 cases of ARF were retrospectively collected.


METHODS
5 to 15 years of age and diagnosis of ARF confirmed by 2 or more rheumatologists, sustained for at least 6 months and two or more visits.


RESULTS
Girls had more chorea (23/50.0% vs. 5/14.3%)(p< 0.0001). Cardiovascular (65/80.2%) and joint involvements (63 / 77.8%) were the most frequent manifestations. Fever was noted in roughly half of the patients. Arthritis was more frequent than arthralgia (47/58.0% vs. 16/19.8%, respectively) (p< 0.0001); however, no specific pattern of joint involvement was found to be more prevalent. Mitral insufficiency was the most frequently detected echocardiographic sign (53 / 93.0%) and its association with aortic insufficiency was noted in 27 / 47.4% patients. Only 24 / 29.6% patients fulfilled Jones criteria for ARF requiring an evidence of previous group-A streptococcal infection (GASI). When compulsory GASI was disregarded, this number rose to 71/87.7% patients (p< 0.0001).


CONCLUSIONS
Girls were more affected by chorea; heart valves and joints were equally affected and represented the major clinical features; no specific pattern of joint involvement (eg.: migratory arthritis) could be labeled as typical; and strict adherence to Jones criteria, with compulsory documentation of a previous GASI, may lead to underdiagnosis of ARF.
Pereira
Breno A F
BA
Projeto PRONUCLEAR, Brazilian Society of Rheumatology and Hospital das Clínicas, Federal University of Goiás, Brazil. bafape@bol.com.br
da Silva
Nilzio Antonio
NA
Andrade
Luis E C
LE
Lima
Flavio S
FS
Gurian
Fernanda C
FC
de Almeida Netto
Joaquim Caetano
JC
D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D018771:Arthralgia / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D003951:Diagnostic Errors; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005334:Fever / Q000503:physiopathology; D006337:Heart Murmurs / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology