Duckett Jones Criteria for Diagnosing Acute Rheumatic Fever

Study Notes

Duckett Jones Criteria

Developed in 1944, with the most recent review in 2015
Considers risk within a population
Has two different pathways:
- Prioritizes specificity among those at low risk
- Prioritizes sensitivity among moderate to high risk

Diagnosis of Acute Rheumatic Fever (ARF)

5 major criteria and 4 minor criteria
Absolute criterion: evidence of recent GAS infection
Diagnosis made with:
- 2 major criteria or
- 1 major and 2 minor criteria, and evidence of recent GAS infection

Major Criteria in Low Risk

Carditis (clinical and/or subclinical)
Polyarthitis
Chorea
Erythema marginatum
Subcutaneous nodules

Minor Criteria in Low Risk

Prolonged PR interval (if carditis is not a major factor)
Polyarthralgia
Fever ≥ 38.5°C
Peak ESR ≥ 60mm/hr and/or CRP ≥ 3mg/dl

ARF Recurrence

2 major criteria
1 major and 2 minor criteria
3 minor criteria
In a patient with a history of ARF or Rheumatic heart disease and documented GAS infection

Introduction to ARF

Inflammatory disease resulting from an abnormal immunological response to pharyngitis caused by GAS
Causes fleeting arthritis and may cause severe/permanent cardiac damage
Occurs 2-5 weeks after pharyngitis
Has a tendency to reoccur

Aetiology

Related to Lancefield group A β-hemolytic streptococcal pharyngitis
The risk of developing rheumatic fever after pharyngitis is 0.3-3%
Over 70 serological types exist, with 10 associated with ARF

Epidemiology

Annual incidence in developing countries: 282/100,000 people
Most common cause of acquired heart disease in all age groups
Commoner in females
Occurs more between the ages of 5 and 15 years
Poverty and overcrowding are risk factors
Incidence reduced in developed countries due to improved living standards and availability of healthcare/antibiotics

Pathogenesis

Cytotoxic theory: suggests a GAS toxin is involved in pathogenesis of ARF
Immune-mediated pathogenesis of ARF: supported by the presence of a latent period between pharyngitis and ARF

Clinical Manifestation and Diagnosis

Determined by revised Jones criteria
Carditis (50-60%): most serious manifestation, accounts for most morbidity and mortality
Chorea (10-15%): emotional lability, incoordination, poor school performance, uncontrollable movements, and facial grimacing

Description

This quiz covers the Duckett Jones Criteria, developed in 1944, for diagnosing Acute Rheumatic Fever (ARF). It considers risk within a population and has two different pathways. Learn about the 5 major and 4 minor criteria for diagnosis.