Australian guidelines for diagnosis of ARF

Table 1: The 2012 Australian guidelines for the diagnosis of ARF (modified Jones criteria)

 

High-risk groups(a)

All other groups

Definite initial episode of ARF

2 major or 1 major and 2 minor manifestations plus evidence of a preceding Strep A infection(b)

2 major or 1 major and 2 minor manifestations plus evidence of a preceding Strep A infection(b)

Definite recurrent episode of ARF in a patient with known past ARF or RHD

2 major or 1 major and 1 minor or 3 minor manifestations plus evidence of a preceding Strep A infection(b)

2 major or 1 major and 1 minor or 3 minor manifestations plus evidence of a preceding Strep A infection(b)

Probable ARF
(first episode or recurrence)

A clinical presentation that falls short by either one major or one minor manifestation, or the absence of streptococcal serology results, but one in which ARF is considered the most likely diagnosis. Such diagnoses should be further categorised according to the level of confidence with which the diagnosis is made:

Highly suspected ARF

Uncertain ARF

A clinical presentation that falls short by either one major or one minor manifestation, or the absence of streptococcal serology results, but one in which ARF is considered the most likely diagnosis. Such diagnoses should be further categorised according to the level of confidence with which the diagnosis is made:

Highly suspected ARF

Uncertain ARF

Major manifestations


Carditis (including subclinical evidence of rheumatic valvulitis on echocardiogram)

Polyarthritis(c) or aseptic mono-arthritis or polyarthralgia

Chorea(d)

Erythema marginatum(e)

Subcutaneous nodules

Carditis (excluding subclinical evidence of rheumatic valvulitis on echocardiogram)

Polyarthritis(c)

Chorea(d)

Erythema marginatum(e)

Subcutaneous nodules

Minor manifestations

Monoarthralgia

Fever(f)

ESR(h) ≥30mm/h or CRP(h) ≥30 mg/L

Prolonged P-R interval on ECG(g)

Fever(f)

Polyarthralgia or aseptic mono-arthritis

ESR(h) ≥30 mm/h or CRP(h) ≥30 mg/L

Prolonged P-R interval on ECG(g)(h)

CRP = C-reactive protein

ECG = electrocardiogram

ESR = erythrocyte sedimentation rate

Strep A = group A streptococcus
 

  1. High-risk groups are those living in communities with high rates of ARF (incidence>30/100,000 per year in 5–14 year olds) or RHD (all-age prevalence >2/1000). Aboriginal people and Torres Strait Islanders living in rural or remote settings are known to be at high risk. Data are not available for other populations, but Aboriginal and Torres Strait Islander people living in urban settings, Maoris and Pacific Islanders, and potentially immigrants from developing countries, may also be at high risk.
  2. Elevated or rising antisreptolysin O or other streptococcal antibody, or a positive throat culture or rapid antigen test for Strep A.
  3. A definite history of arthritis is sufficient to satisfy this manifestation. Note that if polyarthritis is present as a major manifestation, polyarthralgia or aseptic mono-arthritis cannot be considered an additional minor manifestation in the same person.
  4. Chorea does not require other manifestations or evidence of preceding Strep A infection, provided other causes of Chorea are excluded.
  5. Care should be taken not to label other rashes, particularly non-specific viral exanthemas, as erythema marginatum.
  6. Oral, tympanic or rectal temperature ≥38°C on admission, or a reliably reported fever documented during the current illness.
  7. If carditis is present as a major manifestation, a prolonged P-R interval cannot be considered an additional minor manifestation.

Source: RHD Australia 2012.