diff --git a/atlas/migrations/0086_add_canonical.py b/atlas/migrations/0086_add_canonical.py
new file mode 100644
index 00000000..393e615e
--- /dev/null
+++ b/atlas/migrations/0086_add_canonical.py
@@ -0,0 +1,69 @@
+from django.db import migrations, models
+
+
+def forwards(apps, schema_editor):
+    Condition = apps.get_model("atlas", "Condition")
+    # Build connected components using existing M2M 'synonym' links
+    visited = set()
+
+    for cond in Condition.objects.all():
+        if cond.pk in visited:
+            continue
+        # BFS/DFS to collect component
+        stack = [cond]
+        comp = []
+        while stack:
+            c = stack.pop()
+            if c.pk in visited:
+                continue
+            visited.add(c.pk)
+            comp.append(c)
+            # access existing M2M relations
+            for s in c.synonym.all():
+                if s.pk not in visited:
+                    stack.append(s)
+
+        # choose canonical: prefer primary==True else lowest pk
+        canon = None
+        for c in comp:
+            if getattr(c, "primary", False):
+                canon = c
+                break
+        if not canon:
+            canon = min(comp, key=lambda x: x.pk)
+
+        # set canonical for all non-canonical members
+        for c in comp:
+            if c.pk != canon.pk:
+                c.canonical_id = canon.pk
+                c.save()
+
+
+def backwards(apps, schema_editor):
+    Condition = apps.get_model("atlas", "Condition")
+    for c in Condition.objects.all():
+        if c.canonical_id:
+            c.canonical_id = None
+            c.save()
+
+
+class Migration(migrations.Migration):
+
+    dependencies = [
+        ("atlas", "0085_rename_case_detail_caseprior_casedetail_and_more"),
+    ]
+
+    operations = [
+        migrations.AddField(
+            model_name="condition",
+            name="canonical",
+            field=models.ForeignKey(
+                related_name="aliases",
+                null=True,
+                on_delete=models.SET_NULL,
+                to="atlas.condition",
+                blank=True,
+            ),
+        ),
+        migrations.RunPython(forwards, backwards),
+    ]
diff --git a/atlas/migrations/0087_alter_condition_canonical.py b/atlas/migrations/0087_alter_condition_canonical.py
new file mode 100644
index 00000000..d0714370
--- /dev/null
+++ b/atlas/migrations/0087_alter_condition_canonical.py
@@ -0,0 +1,19 @@
+# Generated by Django 5.2.7 on 2025-11-20 22:35
+
+import django.db.models.deletion
+from django.db import migrations, models
+
+
+class Migration(migrations.Migration):
+
+    dependencies = [
+        ('atlas', '0086_add_canonical'),
+    ]
+
+    operations = [
+        migrations.AlterField(
+            model_name='condition',
+            name='canonical',
+            field=models.ForeignKey(blank=True, help_text='If set, this Condition is an alias and points to the canonical Condition.', null=True, on_delete=django.db.models.deletion.SET_NULL, related_name='aliases', to='atlas.condition'),
+        ),
+    ]
diff --git a/atlas/models.py b/atlas/models.py
index 03d63482..03c31d98 100644
--- a/atlas/models.py
+++ b/atlas/models.py
@@ -116,30 +116,66 @@ class SynMixin(object):
             return f"{self.name} [syn]"
 
     def get_old_str(self) -> str:
+        # Prefer using a model-specific get_synonyms (e.g. Condition.get_synonyms)
+        try:
+            syns = self.get_synonyms()
+        except Exception:
+            syns = None
+
         if self.primary:
-            if self.synonym.count() == 0:
-                return self.name
-            else:
+            if syns is None:
+                if getattr(self, "synonym", None) is None or self.synonym.count() == 0:
+                    return self.name
                 synonyms = ",".join([i.name for i in self.synonym.all()])
                 return f"{self.name} ({synonyms})"
+            else:
+                if not syns:
+                    return self.name
+                synonyms = ",".join([i.name for i in syns])
+                return f"{self.name} ({synonyms})"
         else:
             return f"{self.name} [syn]"
 
     def get_synonym(self):
-        if self.primary:
+        # Return a readable synonym string. For models that implement
+        # get_synonyms (Condition with canonical/aliases), use that.
+        try:
+            syns = self.get_synonyms()
+        except Exception:
+            syns = None
+
+        if getattr(self, "primary", False):
             return "[Primary]"
         else:
-            s = self.synonym.filter(primary=True).values_list("name", flat=True)
-            return ", ".join(s)
+            if syns is None:
+                s = self.synonym.filter(primary=True).values_list("name", flat=True)
+                return ", ".join(s)
+            else:
+                # prefer primary names among synonyms if present
+                primary_names = [i.name for i in syns if getattr(i, "primary", False)]
+                if primary_names:
+                    return ", ".join(primary_names)
+                return ", ".join([i.name for i in syns])
 
     def get_synonym_link(self):
-        if self.primary:
+        try:
+            syns = self.get_synonyms()
+        except Exception:
+            syns = None
+
+        if getattr(self, "primary", False):
             return "[Primary]"
         else:
-            syns = self.synonym.filter(primary=True)
-            return ", ".join(
-                [f"<a href='{s.get_absolute_url()}'>{s.name}</a>" for s in syns]
-            )
+            if syns is None:
+                # fall back to all M2M synonyms (not just primary) for models
+                # that still use the old synonym field (e.g. Finding, Structure)
+                syns_qs = self.synonym.all()
+                items = [f"<a href='{s.get_absolute_url()}'>{s.name}</a>" for s in syns_qs]
+                return ", ".join(items)
+            else:
+                # render links for synonyms/canonical group
+                items = [f"<a href='{s.get_absolute_url()}'>{s.name}</a>" for s in syns]
+                return ", ".join(items)
 
     def get_link(self):
         return format_html("<a href='{}'>{}</a>", self.get_absolute_url(), self.name)
@@ -163,6 +199,16 @@ class Condition(SynMixin, models.Model):
         blank=True,
         help_text="Use if a direct synonym for the condition exists, e.g. 'Wegener granulomatosis' and 'Granulomatosis with Polyangitis'.",
     )
+    # New canonical/alias field (Option B): if set, this Condition is an alias
+    # and points to the canonical/master Condition.
+    canonical = models.ForeignKey(
+        "self",
+        null=True,
+        blank=True,
+        on_delete=models.SET_NULL,
+        related_name="aliases",
+        help_text="If set, this Condition is an alias and points to the canonical Condition.",
+    )
     parent = models.ManyToManyField(
         "self",
         blank=True,
@@ -198,6 +244,23 @@ class Condition(SynMixin, models.Model):
     def get_absolute_url(self):
         return reverse("atlas:condition_detail", kwargs={"pk": self.pk})
 
+    @property
+    def canonical_condition(self):
+        """Return the canonical/master condition for this Condition (self if none)."""
+        return self.canonical if self.canonical else self
+
+    def get_synonyms(self):
+        """Return other Conditions that are synonyms/aliases for this concept.
+
+        Behaviour:
+        - If this Condition is an alias (canonical set), return the canonical and
+          any other aliases (excluding self).
+        - If this Condition is canonical, return all aliases (and exclude self).
+        """
+        master = self.canonical_condition
+        qs = Condition.objects.filter(models.Q(canonical=master) | models.Q(pk=master.pk)).exclude(pk=self.pk)
+        return qs
+
     def get_children(self):
         return self.child.all()
 
diff --git a/atlas/templates/atlas/condition_detail.html b/atlas/templates/atlas/condition_detail.html
index 24b03640..a0fa25d5 100755
--- a/atlas/templates/atlas/condition_detail.html
+++ b/atlas/templates/atlas/condition_detail.html
@@ -18,7 +18,7 @@
                 <h5 class="mb-2">Details</h5>
                 <dl class="row">
                         <dt class="col-sm-4">Primary name</dt>
-                        <dd class="col-sm-8">{{ condition.primary }}</dd>
+                        <dd class="col-sm-8">{% if condition.canonical %}No (alias of <a href="{{ condition.canonical.get_absolute_url }}">{{ condition.canonical.name }}</a>){% else %}Yes{% endif %}</dd>
 
                         <dt class="col-sm-4">Subspecialty</dt>
                         <dd class="col-sm-8">
diff --git a/atlas/templates/atlas/finding_detail.html b/atlas/templates/atlas/finding_detail.html
index c7e502e6..715f06ad 100755
--- a/atlas/templates/atlas/finding_detail.html
+++ b/atlas/templates/atlas/finding_detail.html
@@ -12,8 +12,8 @@
     </div>
     <div>
         <h3>Name: {{finding.name}}</h3>
-        Primary name: {{finding.primary}}<br />
-        Synonyms: {{finding.synonym.all|join:", "}}<br />
+    Primary name: {% if finding.canonical %}No (alias of <a href="{{ finding.canonical.get_absolute_url }}">{{ finding.canonical.name }}</a>){% else %}Yes{% endif %}<br />
+    Synonyms: {{ finding.get_synonym_link|safe }}<br />
     </div>
     {% if finding.seriesfinding_set.all %}
         <h4>Associated Cases</h4>
diff --git a/atlas/templates/atlas/partials/_synonyms_list.html b/atlas/templates/atlas/partials/_synonyms_list.html
index c3a99c84..73e62c50 100644
--- a/atlas/templates/atlas/partials/_synonyms_list.html
+++ b/atlas/templates/atlas/partials/_synonyms_list.html
@@ -1,13 +1,15 @@
 {% comment %}Partial that renders the synonyms list + add form. Used by condition_detail and HTMX responses.{% endcomment %}
 {% load static %}
 
-{% if condition.synonym.all %}
-    {% for syn in condition.synonym.all %}
-        <a class="badge bg-secondary text-decoration-none text-white me-1" href="{{ syn.get_absolute_url }}">{{ syn }}</a>
-    {% endfor %}
-{% else %}
-    &mdash;
-{% endif %}
+{% with syns=condition.get_synonyms %}
+    {% if syns %}
+        {% for syn in syns %}
+            <a class="badge bg-secondary text-decoration-none text-white me-1" href="{{ syn.get_absolute_url }}">{{ syn }}</a>
+        {% endfor %}
+    {% else %}
+        &mdash;
+    {% endif %}
+{% endwith %}
 
 {% if request.user.is_authenticated and can_merge %}
     <div class="mt-2 d-flex gap-2">
diff --git a/atlas/templates/atlas/structure_detail.html b/atlas/templates/atlas/structure_detail.html
index ee99fe20..75ef1243 100755
--- a/atlas/templates/atlas/structure_detail.html
+++ b/atlas/templates/atlas/structure_detail.html
@@ -14,8 +14,8 @@
     </div>
     <div>
         <h3>Name: {{structure.name}}</h3>
-        Primary name: {{structure.primary}}<br />
-        Synonyms: {{structure.synonym.all|join:", "}}<br />
+    Primary name: {% if structure.canonical %}No (alias of <a href="{{ structure.canonical.get_absolute_url }}">{{ structure.canonical.name }}</a>){% else %}Yes{% endif %}<br />
+    Synonyms: {{ structure.get_synonym_link|safe }}<br />
     </div>
     <h4>Associated Cases</h4>
     <ul>
diff --git a/atlas/views.py b/atlas/views.py
index 7bb09520..0c6cb6f7 100755
--- a/atlas/views.py
+++ b/atlas/views.py
@@ -868,14 +868,31 @@ def condition_detail(request, pk):
         if not other and synonym_name:
             other, created = Condition.objects.get_or_create(name=synonym_name)
             if created:
-                # mark created synonym as non-primary
-                other.primary = False
-                other.save()
+                # created condition: treat as alias by setting canonical below
+                pass
 
         if other and other != condition:
-            # add mutual synonym relationship
-            condition.synonym.add(other)
-            other.synonym.add(condition)
+            # Option B: treat synonym as alias/canonical relationship.
+            # Determine canonical/master for the current condition
+            master = condition.canonical if condition.canonical else condition
+
+            # If `other` belongs to a different canonical group, move its group
+            # to point at our master. If `other` has no canonical, set it.
+            if other.canonical:
+                # move the whole other group (canonical + aliases) to our master
+                    group_master = other.canonical
+                    members = Condition.objects.filter(Q(canonical=group_master) | Q(pk=group_master.pk))
+                    for m in members:
+                        if m.pk != master.pk:
+                            m.canonical = master
+                            m.save()
+            else:
+                # other is standalone; make it an alias of our master
+                other.canonical = master
+                other.save()
+
+            # Master is indicated by having no `canonical` pointer. Ensure
+            # it remains canonical (no save required unless changed elsewhere).
 
         # If this was an HTMX request return the updated synonyms partial so the
         # page can be updated without a full redirect. Otherwise perform the