Technical notes

Table T1: The 2020 Australian guideline for the diagnosis of acute rheumatic fever (modified Jones criteria)
Diagnosis or manifestation typeHigh-risk groups(a)All other groups
Definite initial episode of acute rheumatic fever (ARF)2 major or one major and 2 minor manifestations plus evidence of a preceding group A streptococcus (Strep A) infection(b)2 major or one 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 rheumatic heart disease (RHD)2 major or one major and 2 minor or 3 minor manifestations plus evidence of a preceding Strep A infection(b)
In the 2012 guidelines, 2 major or one major and one minor or 3 minor manifestations plus evidence of a preceding Strep A infection(b)		2 major or one major and 2 minor or 3 minor manifestations plus evidence of a preceding Strep A infection(b)
In the 2012 guidelines, 2 major or one major and one 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 nodule
  • Carditis (including subclinical evidence of rheumatic valvulitis on echocardiogram) In the 2012 guidelines, Carditis (excluding subclinical evidence of rheumatic valvulitis on echocardiogram)
  • Polyarthritis(c)
  • Chorea(d)
  • Erythema marginatum(e)
  • Subcutaneous nodules
Minor manifestations
  • Monoarthralgia
  • Fever(f)
  • ESR≥30 mm/h or CRP ≥30 mg/L
  • Prolonged P-R interval on ECG(g)
  • Fever(f)
  • Polyarthralgia or aseptic mono-arthritis
  • ESR ≥60 mm/h (ESR ≥30 mm/h in the 2012 guidelines) or CRP ≥30 mg/L 
  • Prolonged P-R interval on ECG(g)

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). First Nations people living in Inner regional and outer regional or Remote and very remote settings are known to be at high risk. Data are not available for other populations, but First Nations people living in urban settings, Māori and Pacific Islanders, and potentially immigrants from developing countries, may also be at high risk.
  2. Elevated or rising antistreptolysin 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 ≥38.5°C (≥38°C in the 2012 guidelines) 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.
  8. Based on the World Heart Federation guidelines, the Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease had been revised and was published in mid-2025. Changes to RHD classification will be implemented in the RHD Registers from 2025, but they are not reflected in the National RHD data collection or in this report. All data provided in this report relates to the existing RHD classification as published in the 2020 version of the Australian guideline.

Source: RHDAustralia 2022.

Table T2: Abbreviations
TermDescription
ABSAustralian Bureau of Statistics
ACTAustralian Capital Territory
AIHWAustralian Institute of Health and Welfare
ARFacute rheumatic fever
BPGbenzathine benzylpenicillin G
CNOSCanadian National Occupancy Standard
ECGelectrocardiography
NSWNew South Wales
NTNorthern Territory
QldQueensland
RHDrheumatic heart disease
SASouth Australia
Strep Agroup A streptococcal infection
TasTasmania
VicVictoria
WAWestern Australia
Table T3: Symbols
SymbolDefinition
n.p.not publishable because of small numbers, confidentiality or other concerns about the quality of the data
≥greater than or equal to
≤less than or equal to
. .not applicable
—nil or rounded to zero


RHDAustralia (ARF/RHD writing group) (2022) ‘The 2020 Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease- external site opens in new window’, (3.2 edition, March 2022), RHDAustralia, Menzies School of Health Research, Darwin.

Previous page
Next page