Rheumatic Fever: Natural History and Treatment

The label of rheumatic fever is now given to a population of patients more distinct and diagnostically "pure" than ever before. The Jones criteria, described in 1944 and modified in 1956 (American Heart Association, 1956), circumscribe the diagnostic boundaries of the disease, and exclude many minor illnesses that formerly were designated inappropriately as rheumatic fever. Other major illnesses that once successfully masqueraded as rheumatic fever, because they fulfilled the Jones criteria, can now be unmasked and properly identified by specific laboratory tests (such as those used for lupus erythematosus, rheumatoid arthritis, and sickle cell anemia) and by cardiac catheterization (for congenital heart disease). These diagnostic purifications improve the homogeneity and reproducibility of a population of patients with rheumatic fever, thus improving the reliability of conclusions drawn from observations of the population.