Expansion
JONES for the major criteria, FEAR for the minor
Expansion
JONES, the major criteria (write it as J-heart-NES, since the O is a heart):
- J - Joints: migratory polyarthritis of the large joints
- O - the heart (carditis and valvulitis), the O being a heart shape
- N - Nodules, subcutaneous, over extensor surfaces
- E - Erythema marginatum, a pink ring shaped rash on the trunk
- S - Sydenham’s chorea, which may appear months later
FEAR, the minor criteria:
- F - Fever
- E - Elevated ESR and CRP
- A - Arthralgia
- R - prolonged PR interval
Diagnosis: evidence of a preceding group A streptococcal infection (raised ASO titre, positive throat culture or recent scarlet fever) plus two major, or one major and two minor criteria.
“It licks the joints but bites the heart.” The arthritis is migratory and resolves completely, while the carditis causes permanent valve damage, most often mitral stenosis years later.
It is a type II hypersensitivity reaction from molecular mimicry between streptococcal M protein and cardiac myosin, occurring 2 to 4 weeks after pharyngitis, and it is prevented by treating streptococcal throat infection.