Medical Mnemonics: Major and Minor Criteria for Rheumatic Fever

Medical Mnemonic of the Week: Rheumatic Fever (“JONES CAFE PAL”)


Medical Mnemonic for Rheumatic Fever is Jones Cafe Pal

Medical Mnemonic: Rheumatic Fever – Jones Cafe Pal


Rheumatic fever occurs after a streptococcal infection (usually caused by Group A Beta-Hemolytic Strep (GABHS)). It is an inflammatory condition that affects the joints, skin, heart and brain. Major criteria are referred to as Jones criteria and can be remembered by the mnemonic of the same name.


  • J – Joint involvement which is usually migratory and inflammatory joint involvement that starts in the lower joints and ascends to upper joints
  • O – (“O” Looks like heart shape) – indicating that patients can develop myocarditis or inflammation of the heart
  • N – Nodules that are subcutaneous
  • E – Erythema marginatum which is a rash of ring-like lesions that can start in the trunk or arms. When joined with other rings, it can create a snake-like appearance
  • S – Sydenham chorea is a late feature which is characterized by jerky, uncontrollable, and purposeless movements resembling twitches

    Minor criteria include
  • C – CRP Increased
  • A – Arthralgia
  • F – Fever
  • E – Elevated ESR
  • P – Prolonged PR Interval
  • A – Anamesis
  • L – Leukocytosis

    Diagnosis of rheumatic fever is made after a strep infection (indicated by either throat cultures growing GABHS OR elevated anti-streptolysin O titers in the blood) and:
  • Two major criteria OR
  • One major criterion and two minor criteria

    Mnemonics by themselves are not the answer to remembering everything. However, if you know the basics and underlying issues, then a mnemonic can serve to help you recall the exam details that can easily get lost.


    This is the first in our series of Medical Mnemonics Monday posts. You can see all future medical mnemonics here.

    January 14, 2014


    January 14, 2014

    Interesting. Here’s the mnemonic I’ve used for 35 years, and I believe it captures the true major Jones criteria:
    P ancarditis
    A rthritis
    N odules, SQ
    E rythema marginatum
    S ydenham chorea

    “Take PANES* and you can remember the major Jones criteria of RF.”

    This is so self-evident I just assumed everyone must have developed something very similar, if not identical.

    Remember, it’s neither pericarditis, nor merely myocarditis – it’s pan-carditis – all 3 layers are involved. Also, “Joint” doesn’t differentiate between true arthritis and arthralgia, a minor criterion. “O” might suggest an oval, or ovoid structure, or a heart, but it might mean “zero”, or “I’m drawing a blank on this ‘mnemonic'”!

    We both saw “nodules”, “erythema m.”, and Sydeham” as straightforward in this acrostic, although I’ve never found a satisfactory differentiator between EM and the commoner erythema nodosum (EN). I’ve just remembered that E rythema is the “other one”, and the SQ nodules reinforces that recollection.

    I haven’t bothered with a mnemonic for the minor criteria as thinking of RF in the differential is adequate, and having done that, looking up the minor is easy. I do remember that mere joint pain* is a minor criterion, as I noted previously. For the same reason, I memorized only the initial Ranson criteria as these are the important presenting signs and symptoms.**

    *Yes, you are correct. PANES and pains are homophones and have different meanings. Perhaps you prefer “Peering through the PANES perceives the major Jones criteria of RF”.
    **Correct again. APACHE is in, Ranson – off to the dustbin.

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