**Question:** Which is not a major criteria of Jones in Rheumatic fever?

A. Carditis
B. Sydenham's chorea
C. Arthritis
D. Valvulitis

**Core Concept:** Rheumatic fever is an infectious disease caused by group A beta-hemolytic Streptococcus (GABHS) infection that leads to inflammation and damage in various organs, particularly the heart, brain, joints, and skin. According to the Jones criteria, major criteria are used to establish the diagnosis of rheumatic fever.

**Why the Correct Answer is Right:** A major criterion for diagnosing rheumatic fever is the presence of at least one major criterion and one minor criterion. Among the options provided, D (Valvulitis) is not one of the major criteria. The major criteria are:

1. Carditis: Inflammation of the heart, which is manifested as a history of fever, acute chest pain, or signs of heart failure on examination.
2. Sydenham's chorea: Uncontrollable, involuntary movements, usually affecting the face and upper extremities, typically seen in children and adolescents.
3. Arthritis: Joint inflammation, often asymmetrical and affecting multiple joints, usually lasting more than one week.
4. Valvulitis: Inflammation of the heart valves, which may lead to regurgitation or stenosis. This is not a major criterion.

**Why Each Wrong Option is Incorrect:**

A. Sydenham's chorea is a clinical feature of rheumatic fever and is considered a major criterion.
B. Arthritis is also a major criterion, as mentioned above.
C. Carditis is a crucial feature of rheumatic fever and is also considered a major criterion.

**Clinical Pearl:** The presence of at least one major criterion or two minor criteria helps establish the diagnosis of rheumatic fever. Understanding these criteria is essential for clinical decision-making, diagnosis, and appropriate treatment of rheumatic fever.