The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries.
The Jones criteria has longed served as the primary guideline for diagnosing acute rheumatic fever (ARF). However, since the first iteration in 1944, the global epidemiology of ARF and our knowledge regarding the variability of its presentation have changed. In 2015, the American Heart Association took on an ambitious and successful revision, which accounts for these changes. For the first time, the criteria consider the risk within a population and offer two separate diagnostic pathways that prioritise specificity among those at low risk and sensitivity among those at moderate/high risk. Echocardiography is now recommended in all patients with suspected or confirmed ARF, and subclinical carditis can fulfil a major criterion for ARF in all populations. Finally, new and specific criteria are provided for the diagnosis of ARF recurrences. These changes improve the diagnosis of ARF among moderate/high-risk populations and re-establish the Jones criteria as the international gold standard for ARF diagnosis. It is our hope that they will also serve as a catalyst in the global community to increase advocacy, improve case detection, and invest in new research techniques that could ultimately control global ARF in our lifetimes.
Children's National Health System, Cardiology , Washington DC , USA.
Andrea
A
Beaton
Telethon Kids Institute, University of Western Australia, and Princess Margaret Hospital for Children , Subiaco, Western Australia , Australia.
Jonathan
J
Carapetis
INFECTION; VALVULAR DISEASE