Duckett Jones Criteria for Diagnosing Acute Rheumatic Fever

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