Jones1 divided the symptoms and signs of rheumatic fever into major and minor manifestations. Aware that other disease states may produce similar symptom complexes, he cautioned that his criteria be used only as a guide and that each sign and symptom be correlated with consideration of the patient as a whole. This is so important that it bears further emphasis. According to the American Heart Association,2 to make a reasonably presumptive diagnosis of rheumatic fever, at least two of the major manifestations, or one of the major and two of the minor manifestations, must be present.
The major manifestations include arthritis, carditis, and chorea (table 1). Typically, arthritis begins in one joint and then travels to involve others; thus, the term migratory polyarthritis. The individual joint is red, hot, swollen, and painful. Fluid drawn from such a joint fails to yield any bacterial organisms. This symptom varies in
Saslaw MS. RHEUMATIC FEVER—DIAGNOSIS, PROPHYLAXIS, AND THERAPY. JAMA. 1955;159(7):653–656. doi:10.1001/jama.1955.02960240019005