This study documented whether patients diagnosed with Acute Rheumatic Fever (ARF) in North Queensland, Australia conformed to the 1992 Revised Jones Criteria (RJC). We aimed to determine whether inclusion of subclinical carditis (SCC) and monoarthritis as major manifestations and a low-grade temperature as a minor manifestation in the RJC are justified in this population. A retrospective review of patients in whom the diagnosis of ARF relied on the experience of clinicians and who were admitted to the Townsville and Cairns Base Hospitals between 1997 and 2007 was undertaken. Of the 98 cases reviewed, 71.4% satisfied the RJC. Modification of the RJC increased the rate of criteria satisfaction to 91.8%. On presentation, 27 patients had SCC. Of the patients with SCC followed up, 70.5% had long-term valvular consequences. In populations endemic for ARF, monoarthritis, SCC and a low-grade temperature should be included in the RJC.