Major criteria (Jones criteria for Acute Rheumatic fever) Carditis Clinical and/or subclinical Ahritis Polyahritis only Monoahritis or polyahritis or polyahralgia in moderate to high-risk populations Chorea Erythema marginatum Subcutaneous nodules There is a latent period of ~3 weeks (1-5 weeks) between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF. The exceptions are chorea and indolent carditis, which may follow prolonged latent periods lasting up to 6 months. Syndenham's Chorea - commonly occurs in the absence of other manifestations, follows a prolonged latent period after group A streptococcal infection, and is found mainly in females. ARF almost always affects the large joints--most commonly the knees, ankles, hips, and elbows--and is asymmetric Subcutaneous nodules occur as painless, small (0.5-2 cm), mobile lumps beneath the skin overlying bony prominences (extensor surfaces).