Acute rheumatic fever, Rheumatic carditis, Sydenham’s chorea, Erythema marginatum, Arthritis, Differential diagnosis The revision of the Jones criteria by the American Heart Association allowed the identification and diagnosis of a greater number of cases of Rheumatic Disease (RD); however, the higher incidence of RD is associated with "pathomorphic" phenotypic pictures, making the diagnosis more difficult. Chorea, carditis, arthritis, marginatum erythema are the major criteria for the diagnosis of RD and can represent its clinical onset, but likewise, due to the variety of their associations, they open a range of different differential diagnoses. Through the critical reasoning applied to some clinical cases, these major “criteria” of RD have been discussed to reduce the difficulties of the differential diagnosis.