Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical features to consider when diagnosing rheumatic fever in children include a combination of major and minor manifestations following a preceding group A streptococcal infection.
The major clinical features are:
- Carditis: presenting as tachycardia, new or changed heart murmurs, pericardial friction rub, or signs of heart failure.
- Polyarthritis: typically a migratory arthritis affecting large joints such as knees, ankles, elbows, and wrists, causing pain, swelling, and redness.
- Chorea: involuntary, irregular movements, often involving the face and limbs, sometimes accompanied by emotional lability.
- Subcutaneous nodules: painless, firm lumps over bony prominences or tendons.
- Erythema marginatum: a transient, non-pruritic rash with pink rings and clear centers, often on the trunk and limbs.
Minor criteria include fever, arthralgia, elevated acute phase reactants (ESR, CRP), and prolonged PR interval on ECG.
Diagnosis requires evidence of preceding streptococcal infection, such as a positive throat culture, rapid antigen test, or elevated streptococcal antibody titres.
These features align with the revised Jones criteria, which remain the cornerstone for diagnosis in children, integrating clinical findings with laboratory evidence NICE NG143 Carapetis et al. 2016Alqanatish et al. 2019Hirani et al. 2025.
Key References
- NG143 - Fever in under 5s: assessment and initial management
- CKS - Feverish children - risk assessment and management
- CKS - Scarlet fever
- CKS - Sore throat - acute
- (Carapetis et al., 2016): Acute rheumatic fever and rheumatic heart disease.
- (Alqanatish et al., 2019): Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia.
- (Hirani et al., 2025): Acute rheumatic fever.