New Zealand guidelines for the diagnosis of acute rheumatic fever: small increase in the incidence of definite cases compared to the American Heart Association Jones criteria.

[acute rheumatic fever]

The aim of the study was to compare utilisation of the New Zealand guidelines for the diagnosis of acute rheumatic fever (ARF ) compared to the American Heart Association Jones criteria in a cohort of childrenRetrospective review of 79 consecutive hospital diagnosed cases of ARF referred for secondary penicillin prophylaxis . The 2006 New Zealand guidelines for ARF were applied to the cohort and the diagnostic classification compared to classification using the American Heart Association 1992 Jones criteria . Cases were defined as definite , probable , possible or not ARF . The New Zealand guidelines use subclinical (echocardiographic ) carditis as a major criterion of ARF . Monoarthritis , if associated with anti-inflammatory medicine usage likely preventing polyarthritis , is also accepted as a major criterion .Sixty -six cases were considered to be possible , probable or definite first episode of occurrence ARF . Utilisation of the New Zealand guidelines resulted in 16 % (CL 7 -29 %) more cases defined as definite ARF than using American Heart Association 1992 Jones criteria (59 /66 cases vs 51 /66 cases ). Polyathritis was the most frequent presenting symptom . Of those classified as definite ARF , 11 % had monoarthritis with anti-inflammatory usage . Clinical carditis was present in 55 % and subclinical carditis in 30 %. The utilisation of subclinical carditis as a major criterion influenced the diagnosis to become definite ARF in 8 % of the cohort only , as the remainder had polyarthritis or Sydenham 's chorea as a major criterion .Utilisation of New Zealand guidelines for the diagnosis of ARF result in a modest increase (16 %) in cases classified as definite ARF compared to the 1992 Jones criteria .