Tasty Morsels of EM 052 – Rheumatic Fever and the Jones Criteria

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.

This is something you’re very unlikely to diagnose in Ireland. The real reason for including this is it seems to be a favourite exam question and I put it here in the hope that I’ll remember it. I did look after a couple of kids with ARF when I was in NZ in 2007 but that’s it.

As an acute illness you’re hoping to see

• kid aged 5-15
• Migratory Arthritis
  • usually the earliest manifestation
  • usually large joints
  • one joint just settling while another one flares up. Usually over a 2 week period or so
• Carditis (a poker overuse syndrome?)
  • usually called a pancarditis cause it can affect everything from valves to myocardium
• Sydenham chorea (nothing to do with the Sydenham bypass apparently…)
  • sometimes called St Vitus’s dance. See this video.
• Rash
  • Erythema marginatum
  • serpinginous (what a word!) bright pink macules
  • apparently hot water (bath or shower) could make the rash worse
• Subcutaneous nodules
  • small round and painless over the joints

These are summarised in the Jones criteria:

• Major
  • Arthritis
  • Carditis
  • Chorea
  • Rash
  • Nodules
• Minor
  • Fever >38
  • Arthralgia
  • ESR/CRP rise
  • Prolonged PR interval (without other carditis)

Two major criteria nails it or one major and two minor.

More FOAMed Resources:

• EM Tutorials
• Emergucate
• Cardiophile: includes a 2015 update to the criteria. More echo!

Featured Image:

• Painting by Pieter Brueghel the Younger on Wikipedia CC License. Of note it comes from a wonderful article called ‘dancing mania’.