**Question:** Which of the following is not included in major Jone's criteria -

A. Erythema marginatum
B. Papular urticaria
C. Positive family history of systemic lupus erythematosus (SLE)
D. Acute arthritis

**Core Concept:** Major criteria in the Systemic Lupus Erythematosus (SLE) classification involve clinical manifestations that are associated with the disease. The Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the immune system attacks the body's own tissues and organs.

**Why the Correct Answer is Right:** Positive family history of systemic lupus erythematosus (SLE) is considered a major criterion in the classification of SLE. This criterion relies on the observation that a patient has a first-degree relative with SLE, which increases the risk of developing the disease. However, a positive family history is not considered a clinical manifestation and is thus not included in the list of major Jons' criteria.

**Why Each Wrong Option is Incorrect:**

A. Erythema marginatum (a bullous dermatosis) is a minor criterion in the classification of SLE and does not fulfill the major criteria criteria.
B. Papular urticaria is a skin lesion associated with allergic reactions and is not a clinical manifestation of SLE.
D. Acute arthritis is a frequent manifestation of SLE and fulfills the major criteria.

**Clinical Pearl:** The importance of distinguishing between major and minor criteria in the classification of Systemic Lupus Erythematosus (SLE) is crucial, as it helps in determining the severity of the disease and guiding treatment options. A positive family history of SLE is important for risk stratification but does not fulfill the major criteria.