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ARF Diagnosis in High-Risk Population — RACP Adult Medicine MCQ

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HardCardiologyARF Diagnosis in High-Risk PopulationRACP Adult Medicine

A 15-year-old boy from a high-risk population presents with monoarthritis of the right knee, fever (38.5°C), ESR 55 mm/hr, and a prolonged PR interval on ECG. ASO titre is elevated. He has no rash, carditis, chorea, or subcutaneous nodules. Can acute rheumatic fever be diagnosed?

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Correct answer: A — Major criterion only in high-risk populations

In high-risk populations (including Indigenous Australians), monoarthritis is upgraded to a MAJOR criterion (vs minor in low-risk populations). With one major (monoarthritis) and three minor criteria (fever, elevated ESR, prolonged PR interval) plus evidence of preceding streptococcal infection (elevated ASO), this meets the Jones criteria for initial ARF diagnosis (2 major, OR 1 major + 2 minor, with evidence of preceding strep).

Reference: RHDAustralia – 2024 – ARF; 2015 AHA Jones Criteria