Circulation. 2015 May 19;131(20):1806-18. doi: 10.1161/CIR.0000000000000205. Epub 2015 Apr 23.
Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever.
To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria.
This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.
尽管欧洲和北美的发病率有所下降，但急性风湿热仍然是世界上大多数人严重的医疗保健问题。本研究旨在回顾过去用于诊断急性风湿热的琼斯标准，并根据目前该病的流行病学情况进行更新，同时纳入最近支持使用多普勒超声心动图诊断风湿热的主要表现——心脏炎的证据。
为了实现这一目标，美国心脏协会青年心血管疾病理事会及其风湿热、心内膜炎和川崎病委员会组织了一个写作小组，全面审查和评估了急性风湿热临床表现的人群特异性差异以及非甾体类抗炎药在全球范围内普及所导致的临床表现变化的影响。此外，还对大量支持使用多普勒超声心动图诊断急性风湿热心脏受累的已发表研究进行了方法学评估，即使临床表现不明显，该方法也可用于诊断心脏受累，以确定将亚临床心脏炎定义为主要琼斯标准并将其纳入的证据基础。这一努力导致了自 1992 年以来美国心脏协会对琼斯标准的首次重大修订，也是首次将美国心脏病学会/美国心脏协会制定的推荐分类和证据水平类别应用于琼斯标准。
此次对琼斯标准的修订使其与其他国际急性风湿热诊断指南更加一致，通过定义高危人群、认识到这些高危人群临床表现的变异性以及纳入多普勒超声心动图作为诊断心脏受累的工具。
