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Acute Rheumatic Fever

Features suggestive of Acute Rheumatic Fever include:

  • Joint pain, swelling and warmth primarily affecting large joints, particularly knees, ankles, wrists and elbows. 
  • Usually initially one joint is affected and then migratory (moves to affect other joints) and additive (becomes many joints affected). A monoarthritis pattern is also possible albeit less common than polyarthritis. Joint pain is prominent, occurs at rest and is increased by movement.
  • Associated manifestations may include fever, arthralgia (if not arthritis), carditis (signs ranging from tachycardia at rest, prolonged PR interval, new murmur suggesting mitral and/or aortic insufficiency to acute heart failure), erythema marginatum (non-pruritic, macular, serpiginous rash with erythematous border especially on trunk and upper, inner aspects of limbs), chorea (usually symmetric persistent, involuntary and purposeless movements of extremities) or subcutaneous nodules (extensor surfaces).
  • Diagnosis is made by using the Jones criteria - these have been revised in 2015 (see Further Reading) with major and minor criteria.
  • Evidence of streptococcal infection (streptococcal serology or throat swab positive for group A streptococcus)
  • Acute rheumatic fever is discussed further in the modules - Investigation, Limp and Arthritis.

Further Information:

Guidance to aid diagnosis, prevention and management of rheumatic fever and rheumatic heart disease.


Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. A Scientific Statement From the American Heart Association and on behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Michael H. Gewitz et al. .