Rheumatic Fever

Diagnosis

Diagnosis of rheumatic fever starts with a medical history and physical examination. The healthcare provider may also order diagnostic tests such as:

• A throat culture
• A blood test (including a test to evaluate for a history of strep infection)
• An echocardiogram, or ultrasound of the heart
• A chest X-ray

There is no definitive diagnostic test for rheumatic fever. The American Heart Association has guidelines for the diagnosis of rheumatic fever called the Jones criteria. These guidelines include lab test findings as well as signs and symptoms of the disease. The diagnosis of rheumatic fever is made when two major Jones criteria, or one major criterion plus two minor criteria, are present along with evidence of a previous streptococcal infection.

Major criteria include:

• Carditis (inflammation of the heart) sometimes accompanied by weakness and shortness of breath or chest pain. The physician may suspect heart inflammation as a result of a physical exam or medical tests, such as an electrocardiogram or a chest X-ray.
• Painful arthritis, most often affecting the ankles, wrists, knees and elbows, and moving from joint to joint.
• Jerky movement of the limbs and face, or more subtle movement difficulties, such as difficulty with handwriting (known as Sydenham's chorea).
• Subcutaneous nodules (small, painless bumps under the skin, often over bony areas).
• Rash (a red, irregular rash on the trunk).

Minor criteria include:

• Fever
• Arthralgia (pain in one or more joints without inflammation)
• Abnormal interval measurement on an electrocardiogram (ECG or EKG)
• Blood test indicating inflammation
• New abnormal heart murmur