Rheumatic Fever: Features

Key points

• Follows an immunological reaction to Streptococcus pyogenes infection 2-6 weeks earlier.
• Diagnosis (revised Jones, 2015): evidence of recent streptococcal infection PLUS 2 major, or 1 major + 2 minor. The 2015 revision stratifies by population risk — in moderate/high-risk populations, monoarthritis or polyarthralgia may count and thresholds are lower.
• Evidence of recent strep infection: raised or rising streptococcal antibodies, positive throat swab, or positive rapid group A antigen test.
• Major: carditis/valvulitis (including subclinical carditis on echo, added in 2015), polyarthritis, Sydenham's chorea, erythema marginatum (~10% of children, rare in adults), subcutaneous nodules.
• Minor: raised ESR/CRP, pyrexia, arthralgia (not if arthritis is the major), prolonged PR interval. Carditis requires endocarditis/valvulitis evidence (regurgitant murmur), not pericarditis or myocarditis alone.

Decision points in this pathway

• 2 major OR 1 major + 2 minor?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.