SELF-STUDY MATERIALS (BLOCK I.

1)

MEDICAL TERMINOLOGY
Contributors:
dr. E. Suryadi, SU, PA(K), MHPE
Department of Anatomy
dr. Prattama Santoso Utomo, MHPEd
Department of Medical Education and Bioethics

----------------------------------------------------------------------------------------------------------------

Learning Objectives:
After completing this module, students will be able to:
1. describe the basic word structure of medical terminology
2. describe the meaning of suffixes, prefixes, and roots in medical terminology
3. explain the meaning of commonly used medical terminologies
4. explain the meaning of complex medical words
5. discuss terminologies of the medical specialties available in Indonesia
6. analyze medical terminologies found in medical articles
7. develop a short passage using medical terminologies

Lesson Plan of Medical Terminology:

1. Completing exercises (Self-Study/Independent Learning)
2. Integrated lecture (Synchronous Face-to-Face Session – see Block Schedule)

Instruction for Students:

Please complete the exercise below before attending the panel discussion. Prepare any
questions you need to clarify during the Panel Discussion. Below are videos you might need
to watch:
1. Anatomicomedical Terminology : https://youtu.be/b_Cv_ZvwDsA
2. General Bone Markings : https://youtu.be/88Jz1lQVtYs

References for further reading and self-learning:

Hutton AR. 2002. An Introduction To Medical Terminology For Health Care: A Self Teaching
Package. London: Churchill Livingstone.
Suryadi E. 2005. Buku Saku: Terminologi Kedokteran. Yogyakarta: Fakultas Kedokteran
UGM.

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1. BASIC PRINCIPLES OF MEDICAL TERMINOLOGY

A. Basic Word Structure: Fill in the blanks!

1. Suffix
A word part –logy as in pathology is called a(n) ______________________________________
2. prefix
A word part that comes in front of a root is a(n) _____________________________________
3. ROOT
The foundation of a word is called the ______________________________________________
4. Vowel
A letter linking suffix and root(s) in a word is called the _____________________________
5. combining
A root with a vowel added to help pronunciation is called a(n) _______________________

B. Give the meaning of the following combining forms!

1. Gland
aden/o _______________________________ 12. gnos/o ______________________________
2. function
physio/o _____________________________ Bone
13. oste/o _______________________________
3. white blood cell
leuk/o _______________________________ Cancer
14. onc/o ______________________________
4. Disease
path/o _______________________________ Skin
15. dermat/o ____________________________
5. Head
cephal/o _____________________________ Yellow
16. xanth/o _____________________________
6. Glukoce , Sugar
glyc/o________________________________ Real
17. erythr/o _____________________________
7. Joint
arthr/o ______________________________ Female
18. gynec/o _____________________________
8. Kidney
nephr/o______________________________ Brain
19. encephal/o __________________________
9. Brain
cerebr/o _____________________________ Liver
20. hepat/o _____________________________
Cancer
10. carcin/o _____________________________ Life
21. bi/o _________________________________
11. cyt/o ________________________________
Cell Bladder
22. cyst/o _______________________________

C. Fill in the prefixes for the following English terms!

1. PERI
Surrounding _______________________
-

9. ANTE
Before ______________________________
-

2. MAL
Deficient ___________________________
-

EXTRA / F- CTU IEC /EXO

10. Outside, outer ______________________ -
-
-
-

3. TRANS -

Across _____________________________ INTRA

11. Within _____________________________
-

4. Auto
Self ________________________________
-

RETRO
12. Back _______________________________
-

5. DIA -

Complete, through _________________ HYPER

13. Excessive___________________________
-

6. ANA
Up _________________________________
-
ECTO
14. Out ________________________________
-

7. SUPRA -
SUPER • ULTRA
Above ______________________________
,
-
✗ ANTHO
15. Yellow ______________________________
-

RETRO A Niki Ari

8. Behind _____________________________ 16. No, without _________________________
- - -
-
, ,

D. Fill in the meaning of the following prefixes!

1. AGAIN's
anti - ______________________________ 6. within Beside
intra- ______________________________
.

2. Below
infra- ______________________________ 7. UNDER
sub- ______________________________
3. BEFORE Infront Of
pro- ______________________________
, 8. Extreme , excessive
hyper- ______________________________
4. Between
inter- ______________________________
.
9. con- TOGETHER
______________________________
5. AFTER / BEHINI
meta- _____________________________ 10. in- _________________________________

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11. meso- MIDLLF
_____________________________ 21. retro- BEHIND
______________________________
UP
12. ana- _______________________________ ABOVE
22. ultra- ______________________________
13. ab- ________________________________ complete
23. dia- _______________________________
DOWNWARD
14. cata- _______________________________ RAPID
24. tachy- ______________________________
SURROUNDING
15. peri- ______________________________ 25. pan- _______________________________
MANY
16. poly- _______________________________ SLOW
26. brady-______________________________
ABNORMAL
17. dys- _______________________________ Before
27. ante- ______________________________
FALSE
18. pseudo- ____________________________ NORMAL
28. eu- _________________________________
NEAR
19. para- ______________________________ AGAINTS
29. contra- ____________________________
BAD
20. mal- _______________________________ SELF
30. auto- _______________________________

E. Fill in the suffixes for the following English terms!

1. Inflammation _____________________________________________________________________
ITIS -

2. Sectomy
Resection, or surgical removal _____________________________________________________
-

3. TOMY
Section ___________________________________________________________________________
-

4. 0515
Condition (usually abnormal) ______________________________________________________
-

5. OLOGY
Process of study __________________________________________________________________
6. Scope
Instrument to examine visually ____________________________________________________
-

7. TOME
Instrument to cut _________________________________________________________________
-

8. LOGYST
One who specializes in ____________________________________________________________
-

9. Pertaining to ______________________________________________________________________
EMIA
10. Blood condition ___________________________________________________________________
-

OMA
11. Tumor ____________________________________________________________________________
-

ALGIA / DYNIA
12. Pain ______________________________________________________________________________
-
-

GRAM
13. Record ____________________________________________________________________________
-

LYTE
14. Cell _______________________________________________________________________________
-

OPSY
15. Process of viewing _________________________________________________________________

F. What prefix means the same as:

1. TRANS
per- _______________________________
-

7. ANTE / PRO
pre- _______________________________
- -

2. a-, an- _____________________________ 8. SUPER IUILTRA

supra- _____________________________
- -

SEMI
-

3. hemi- _____________________________ 9. con- _______________________________

ENDO
-

4. intra- ______________________________ 10. cata- ______________________________

5. ANTI -

contra- _____________________________
SUB -

11. infra- ______________________________

6. ECTO -

ex- ________________________________ POST / PASCA -

12. retro- ______________________________

-

G. Fill in the meaning of the following suffixes

1. –gram RECORD
____________________________ 2. Resection
–ectomy ____________________________

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3. Restore
–plasty ____________________________ Tool to measure
15. –graph _____________________________
4. MAKING A HOLE Procedure
– stomy ____________________________ 16. –opsy ______________________________
To View

5. –osis Abnormal Condition

____________________________ Cutting Instrument
17. –tome _____________________________
6. Enlargement
–megaly ____________________________ 18. –pexy ______________________________
Fixation
Inflammation Blood Condition
7. –itis ____________________________ 19. –emia ______________________________
8. Softenine
–malacia ___________________________ 20. –stasis _____________________________
Stop

9. –genic Cause
____________________________ Round Shaped
21. –coccus ____________________________
Pain
10. –dynea _____________________________ Treatment
22. –therapy ___________________________
Recording
11. –graphy ____________________________ Growt
23. –trophy ____________________________
Fourmatron
12. –poiesis ____________________________ Dropping
24. –ptosis _____________________________
Tumour Cut
13. –oma ______________________________ 25. –tomy _____________________________
Taking out fluid
14. –centesis ___________________________ 26. –lysis_______________________________

H. Compound Word: Select the best answer!

1. Which of the following is a compound word?
a. Biology b. Sinusitis c. Dysphagia d. Gastroenteritis
2. The adjective form for thorax is?
a. Thoracic b. Thoraxial c. Thoraxal d. Thoral
3. The word diplopia has the suffix:
a. Opia b. Ia c. Plopia d. Pia

I. Write the plural or singular form of each of the the following words!
1. Plural: Vertebrae Vertebra
Singular: ________________________________________
2. Plural: Nuclei Nucleus
Singular: ________________________________________
3. Singular: Patella patellum
Plural: ___________________________________________
PROGNOSES
4. Singular: Prognosis Plural: ____________________________________________
5. Singular: Pharynx PHARYNGEG
Plural: ___________________________________________
6. Singular: Apex APICES
Plural: ___________________________________________

J. Using slashes (/), divide the following terms into component parts: write the word
root: and give the meaning of the word:
Root Meaning
1. quadriceps CCPHAL
______________________________ Muscle That has 4 Heads
____________________________________
2. cerebral Cerensr
______________________________ Relating To Brain
____________________________________
3. pathogenic PATH
______________________________ Source of Disease
____________________________________
4. GASTR
hypogastric ______________________________ Below The Stomach
____________________________________
5. tetralogy TEFR
______________________________ A Group of four Related literary
____________________________________
6. rhinitis
Rhin
______________________________ Nose lntlamar.cn
____________________________________

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 ARTHA
7. arthrotomy ______________________________ ____________________________________
LYMPH Tumor of thelymph NODE
8. lymphoma ______________________________ ____________________________________
TUMOUR Cause By Excessive Lipid
9. xanthoma ______________________________
✗ ANTH ____________________________________
hole
10. iridotomy IRIDIS
______________________________ Making a
____________________________________
in IRIS

Deron Below the

skin
11. hypodermis ______________________________ ____________________________________
f- 5TH
12. paresthesia ______________________________ Sensation of ABNORMAL Senses
____________________________________
SALDHYNX
13. salphingitis ______________________________ Inflammation of the fallopian tubes
____________________________________
14. vasectomy was
______________________________ cut the Vas Deferens
____________________________________
SPERM fail
15. aspermia ______________________________ ____________________________________
to produce semen

16. tricuspid CUSP

______________________________ Value that contains 3 Leaves
____________________________________
17. sepsis Sep
______________________________ Body 's extreme Response to Infection
____________________________________
CEPHAL
18. biceps ______________________________ Muscle with 2 Heads
____________________________________
Perm Inside the skin
19. intradermal ______________________________ ____________________________________
20. antipyretic
PYR
______________________________ Drug used to Reduce fever
____________________________________
PHREN Below The DIAPHRAGM
21. subphrenic ______________________________ ____________________________________
22. myelitis MYEL
______________________________ Infection of the spinal chord
____________________________________

K. Using slashes divide the following terms into component parts; identify the
combining forms and give the meaning of the word:
Combining Form Meaning
1. carcinogenic Chrono
__________________________ ______________________________
2. electroencephalogram electro + cncephalo
__________________________ ______________________________
3. osteotome OSHO
__________________________ ______________________________
4. thrombocytosis THROMBO
__________________________ ______________________________
BASTROT ENTER 0
5. gastroenterologist __________________________ ______________________________
6. encephalopathy Encephalo
__________________________ ______________________________
electro + My 0
7. electromyography __________________________ ______________________________
Physio
8. physiology __________________________ ______________________________
Chondro
9. chondroma __________________________ ______________________________
10. osteosarcoma Osteo
__________________________ ______________________________
lipid
11. lipase __________________________ ______________________________
psycho
12. psychosis __________________________ ______________________________
13. cheilonychia Cheilo
__________________________ ______________________________
NECRO
14. necrosis __________________________ ______________________________
BIO
15. biology __________________________ ______________________________
16. physiology Physio
__________________________ ______________________________
APO
17. apoptosis __________________________ ______________________________
Thrombo
18. thrombosis __________________________ ______________________________

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19. anisocytosis __________________________ ______________________________
20. asthenia __________________________ ______________________________
21. hemorrhage Nemo
__________________________
-

______________________________
RHINO
22. rhinorrhea __________________________
-
______________________________
23. stenosis STENO
-

__________________________ ______________________________

L. Find the suffixes in the following words and give meaning of the word:
Suffix Meaning
1. leukemia ________________________________
-
EM / A ________________________________
2. gastrectomy ECTOMY
________________________________
-

________________________________
OMA
3. hematoma ________________________________ ________________________________
-

IT IS
4. nephritis ________________________________ ________________________________
-

SCOPE
5. proctoscope ________________________________ ________________________________
-

0515
6. dermatosis ________________________________ ________________________________
-

-
Genic
7. psychogenic ________________________________ ________________________________
8. neuralgia Algid
________________________________
-

________________________________
ectasis
9. bronchiectasis _______________________________ ________________________________
-

10. appendectomy ectomy

_______________________________
-

________________________________
11. melanoma _______________________________
OMA
-
________________________________
ITIS
12. urethritis _______________________________ ________________________________
-

13. colonoscopy SIOPY

_______________________________
-

________________________________
0515
14. dermatosis _______________________________ ________________________________
-

15. psychogenic Genic

_______________________________
-

________________________________
AL GIA
16. neuralgia _______________________________ ________________________________
-

ASE
17. amylase _______________________________ ________________________________
-

RRHEA
18. leucorrhea _______________________________ ________________________________
-

OLD
19. adenoid _______________________________ ________________________________
-

20. erythema EMA

_______________________________ ________________________________
-

-5515
-

21. diuresis _______________________________ ________________________________

-
0514
22. thyrotoxicosis _______________________________ ________________________________
RR HE ✗ 15
23. onychorrhexis _______________________________ ________________________________
-

M. Identify the prefixes in the following terms and give meaning of the word:
Prefix Meaning
1. anatomy _____________________________ ________________________________
2. endocarditis ENDO
_____________________________-

________________________________
3. retroperitoneal RETRO
_____________________________
-

________________________________
4. hypodermic _____________________________ ________________________________

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5. hyperemia _____________________________ ________________________________
6. endocrine _____________________________ ________________________________
7. diagnosis _____________________________ ________________________________
8. prognosis _____________________________ ________________________________
9. endometrium _____________________________ ________________________________
10. periosteum _____________________________ ________________________________
11. ectasis _____________________________ ________________________________
12. ectoderm _____________________________ ________________________________
13. retroperitoneum _____________________________ ________________________________
14. hypothermia _____________________________ ________________________________
15. hyperemesis _____________________________ ________________________________
16. paracrine _____________________________ ________________________________
17. epidermis _____________________________ ________________________________
18. circumoral _____________________________ ________________________________
19. abscess _____________________________ ________________________________
20. abortus _____________________________ ________________________________
21. bifurcatio _____________________________ ________________________________
22. contralateral _____________________________ ________________________________
23. adenocortical _____________________________ ________________________________

N. Fill in the terminology of each of the following medical specialties!

Work field parts Specialty
English terms Indonesian terms
1. internal organs internist Sp.PD
2. skin diseases Dermatologist
_______________________ SP DV
_________________________
-

3. urinary tract
(surgical) UROLOGIST
_______________________ SP U
_________________________
.

4. female reproductive
diseases Gynecologist
_______________________ _________________________
SP OG
-

5. blood related diseases

and tumors Hematologist
_______________________ _________________________
6. tumor and cancers
(surgery) oncologist
_______________________ Sp Blk ) Onk
_________________________
.

7. ear and throat

diseases Otolarynologist
_______________________ Sp THT kl
_________________________
.
-

8. sports and exercise _______________________ sp KO

_________________________
.

9. kidney and urinary

tract diseases _______________________ _________________________

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10. heart disorders Cardiologist
_______________________ sp.JP
_________________________
11. heart (surgery) Cardiothoracic
surgeon
_______________________ SP BTKV
_________________________
-

12. infection and tropical

diseases _______________________ _________________________
13. nerve disorders _______________________ _________________________
14. brain (surgery) _______________________ _________________________
15. radio-imaging/therapy _______________________ _________________________
16. eye diseases _______________________ _________________________
17. bone disorder and
trauma _______________________ _________________________
18. gastro-intestinal
diseases _______________________ _________________________
19. liver and pancreas
(surgical) _______________________ _________________________
20. diseases in children _______________________ _________________________
21. surgical in children _______________________ _________________________
22. mental disorders _______________________ _________________________
23. mouth (surgical) _______________________ _________________________
24. physiotherapy _______________________ _________________________
25. burns and aesthetic
repair (surgical) _______________________ _________________________
26. emergency _______________________ _________________________
27. anesthesia _______________________ _________________________
28. drugs and medicine _______________________ _________________________
29. bacteria and
microorganism _______________________ _________________________
30. nematodes, lice, and
plasmodium _______________________ _________________________
31. aviation and space _______________________ _________________________
32. microscopic study on tumor ______________________ _________________________
33. laboratory analysis _______________________ _________________________

O. Give the meaning of this following terms!

1. Autopsy __________________________________________________________________________
2. Neonatus _________________________________________________________________________
3. Policytemia _______________________________________________________________________
4. Angioedema _______________________________________________________________________
5. Cephalic __________________________________________________________________________

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6. Oligohydramnion __________________________________________________________________
7. Cystitis ___________________________________________________________________________
8. Hepatoma _________________________________________________________________________
9. Varicocele ________________________________________________________________________
10. Dysmenorrhea ____________________________________________________________________
11. Atresia ____________________________________________________________________________
12. Dyspareunia ______________________________________________________________________
13. Salpingo-oophorectomy ___________________________________________________________
14. Hemianopia ______________________________________________________________________
15. dysplasia__________________________________________________________________________
16. transcostal _______________________________________________________________________
17. anomaly __________________________________________________________________________
18. exocrine___________________________________________________________________________
19. chondrodystrophy _________________________________________________________________
20. antiseptic _________________________________________________________________________
21. intravenous _______________________________________________________________________
22. epicardium ________________________________________________________________________
23. bifurcation ________________________________________________________________________
24. diarrhea __________________________________________________________________________
25. amniocentesis _____________________________________________________________________
26. pseudocyesis ______________________________________________________________________
27. diagnosis _________________________________________________________________________
28. prognosis _________________________________________________________________________
29. euthanasia (hint: thanas = death) __________________________________________________
30. agenesis __________________________________________________________________________
31. contraception _____________________________________________________________________
32. dysfunction _______________________________________________________________________
33. asymmetrical______________________________________________________________________
34. perfusion _________________________________________________________________________
35. anti-inflammatory _________________________________________________________________
36. deoxygenation _____________________________________________________________________
37. prolapse __________________________________________________________________________
38. comatose__________________________________________________________________________
39. antenatal _________________________________________________________________________
40. anaerobic _________________________________________________________________________
41. percutaneous _____________________________________________________________________
42. esophagotomy _____________________________________________________________________
43. phagocyte _________________________________________________________________________

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44. lymphosarcoma ___________________________________________________________________
45. resection __________________________________________________________________________
46. ureterectomy ______________________________________________________________________
47. hematocrit ________________________________________________________________________
48. osteolysis _________________________________________________________________________
49. intravenous _______________________________________________________________________
50. bilateral ___________________________________________________________________________

P. Built medical terms:

1. Blood cancer ______________________________________________________________________
2. Inflammation of gland _____________________________________________________________
3. Record of the electricity of the brain ________________________________________________
4. Clotting cells deficiency ____________________________________________________________
5. Pertaining to across the stomach___________________________________________________
6. Ingestion of waste by a cell ________________________________________________________
7. Head pain _________________________________________________________________________
8. Immature red blood cell ___________________________________________________________
9. Formation of a nucleus ____________________________________________________________
10. Instrument to visually examine the eye _____________________________________________
11. Cell with a very large nucleus ______________________________________________________
12. Inflammation of bones and joints __________________________________________________
13. Low blood sugar ___________________________________________________________________
14. Cell that contains fat ______________________________________________________________
15. Absence of the jaw ________________________________________________________________
16. Process of viewing the urinary bladder _____________________________________________
17. Blood vessel tumor ________________________________________________________________
18. Inflammation of the liver ___________________________________________________________
19. Incision of abdominal wall _________________________________________________________
20. Decreased number of red blood cells _______________________________________________
21. Process of visually examining the peritoneum ______________________________________
22. Inflammation of the renal pelvis ____________________________________________________
23. Abnormal condition of white cells (too many) _______________________________________
24. Painful or difficult breathing _______________________________________________________
25. Heart enlargement ________________________________________________________________
26. Increased carbon dioxide in the tissues ____________________________________________
27. Process of study of tissue __________________________________________________________
28. Pertaining to the skull _____________________________________________________________
29. Incision into the chest _____________________________________________________________

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30. Process of food breakdown to produce energy (“casting down”) ______________________
31. Tumor of womb muscle ____________________________________________________________
32. Inflammation of skin ______________________________________________________________
33. Plastic surgery of the (upper) lip ___________________________________________________
34. (abnormal) smallness of the (lower) jaw _____________________________________________
35. An agent that kills virus ___________________________________________________________
36. To cut out (one of) the kidney ______________________________________________________

Q. Provide answers to the following questions!

1. What is mammography? ___________________________________________________________
___________________________________________________________________________________
2. What is intravenous pyelography (IVP)? ____________________________________________
___________________________________________________________________________________
3. What is Cardiopulmonary Resuscitation (CPR)? ____________________________________
___________________________________________________________________________________
4. What is Chronic Myeloid Leukemia (CML)? _________________________________________
___________________________________________________________________________________
5. What is gluteus maximus? _________________________________________________________
___________________________________________________________________________________
6. What is amniocentesis?____________________________________________________________
___________________________________________________________________________________
7. What is ectopic pregnancy? ________________________________________________________
___________________________________________________________________________________
8. What is gynecomastia? ____________________________________________________________
___________________________________________________________________________________
9. What is hemorrhoidectomy? _______________________________________________________
___________________________________________________________________________________
10. What is herniorraphy? _____________________________________________________________
___________________________________________________________________________________

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2. UNDERSTANDING MEDICAL PAPER
Read the following passage and try to list as many medical terminologies/words as possible.
Please also search and the meaning of each terminology.

OSTEOARTHRITIS
Authors: Carlos J Lozada, MD; Schartess S Culpepper Pace, MD; Herbert S Diamond, MD
Source: https://emedicine.medscape.com/article/330487-overview#a1, cited July 24th, 2021

Background
Osteoarthritis is the most common type of joint disease, affecting more than 30 million individuals in the United
States alone. It represents a heterogeneous group of conditions resulting in common histopathologic and
radiologic changes. It has been thought of as a degenerative disorder arising from biochemical breakdown of
articular (hyaline) cartilage in the synovial joints. However, the current view holds that osteoarthritis involves not
only the articular cartilage but also the entire joint organ, including the subchondral bone and synovium.
Osteoarthritis predominantly involves the weight-bearing joints, including the knees, hips, cervical and
lumbosacral spine, and feet. Other commonly affected joints include the distal interphalangeal (DIP), proximal
interphalangeal (PIP), and carpometacarpal (CMC) joints. This article primarily focuses on osteoarthritis of the
hand, knee, and hip joints (see Pathophysiology). For more information on arthritis in other joints, see
Glenohumeral Arthritis and Wrist Arthritis.
Although osteoarthritis was previously thought to be caused largely by excessive wear and tear, increasing
evidence points to the contributions of abnormal mechanics and inflammation. In addition, some invasive
procedures (eg, arthroscopic meniscectomy) can result in rapid progression to osteoarthritis in the knee joint.
Therefore, the term degenerative joint disease is no longer appropriate in referring to osteoarthritis.
Historically, osteoarthritis has been divided into primary and secondary forms, though this division is somewhat
artificial. Secondary osteoarthritis is conceptually easier to understand: It refers to disease of the synovial joints
that results from some predisposing condition that has adversely altered the joint tissues (eg, trauma to articular
cartilage or subchondral bone). Secondary osteoarthritis can occur in relatively young individuals).
The definition of primary osteoarthritis is more nebulous. Although this form of osteoarthritis is related to the aging
process and typically occurs in older individuals, it is, in the broadest sense of the term, an idiopathic
phenomenon, occurring in previously intact joints and having no apparent initiating factor.
Some clinicians limit the term primary osteoarthritis to the joints of the hands (specifically, the DIP and PIP joints
and the joints at the base of the thumb). Others include the knees, hips, and spine (apophyseal articulations) as
well.
As underlying causes of osteoarthritis are discovered, the term primary, or idiopathic, osteoarthritis may become
obsolete. For instance, many investigators believe that most cases of primary osteoarthritis of the hip may, in
fact, be due to subtle or even unrecognizable congenital or developmental defects.
No specific laboratory abnormalities are associated with osteoarthritis. Rather, it is typically diagnosed on the
basis of clinical findings, with or without radiographic studies.
Patophysiology
Primary and secondary osteoarthritis are not separable on a pathologic basis, though bilateral symmetry is often
seen in cases of primary osteoarthritis, particularly when the hands are affected. Traditionally, osteoarthritis was
thought to affect primarily the articular cartilage of synovial joints; however, pathophysiologic changes are also
known to occur in the synovial fluid, as well as in the underlying (subchondral) bone, the overlying joint capsule,
and other joint tissues.

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Although osteoarthritis has been classified as a noninflammatory arthritis, increasing evidence has shown that
inflammation occurs as cytokines and metalloproteinases are released into the joint. These agents are involved in
the excessive matrix degradation that characterizes cartilage degeneration in osteoarthritis. Therefore, it is no
longer appropriate to use the term degenerative joint disease when referring to osteoarthritis.
Studies of interleukin-17 (IL-17), a proinflammatory cytokine, have found increased IL-17 levels in the synovium
of osteoarthritis joints, as is seen in inflammatory arthritis (ie, rheumatoid arthritis). Other inflammatory molecules
that have been associated with osteoarthritis include 15-hydroxyeicosatetraenoic acid, prostaglandin E2, IL-1β,
IL-1 receptor antagonist, and uric acid.
In early osteoarthritis, swelling of the cartilage usually occurs, because of the increased synthesis of
proteoglycans; this reflects an effort by the chondrocytes to repair cartilage damage. This stage may last for
years or decades and is characterized by hypertrophic repair of the articular cartilage.
As osteoarthritis progresses, however, the level of proteoglycans eventually drops very low, causing the cartilage
to soften and lose elasticity and thereby further compromising joint surface integrity. Microscopically, flaking and
fibrillations (vertical clefts) develop along the normally smooth articular cartilage on the surface of an
osteoarthritic joint. Over time, the loss of cartilage results in loss of joint space.
In major weight-bearing joints of persons with osteoarthritis, a greater loss of joint space occurs at those areas
experiencing the highest loads. This effect contrasts with that of inflammatory arthritides, in which uniform joint-
space narrowing is the rule.
In the osteoarthritic knee, for example, the greatest loss of joint space is commonly seen in the medial
femorotibial compartment, though the lateral femorotibial compartment and patellofemoral compartment may also
be affected. Collapse of the medial or lateral compartments may result in varus or valgus deformities,
respectively.
Krasnokutsky et al reported that the serum uric acid level can predict future joint space narrowing. In their study
of 88 patients with medial knee osteoarthritis, over the course of 24 months, mean joint space narrowing of 0.31
mm occurred in patients with a serum uric acid level of less than 6.8 mg/dL (the solubility point for serum urate),
compared with 0.90 mm in those with a serum uric acid level of 6.8 mg/dL or higher (P <  0.01). These authors
suggest that serum uric acid levels may serve as a biomarker for progression of osteoarthritis.
Etiology
The daily stresses applied to the joints, especially the weight-bearing joints (eg, ankle, knee, and hip), play an
important role in the development of osteoarthritis. Most investigators believe that degenerative alterations in
osteoarthritis primarily begin in the articular cartilage, as a result of either excessive loading of a healthy joint or
relatively normal loading of a previously disturbed joint. External forces accelerate the catabolic effects of the
chondrocytes and further disrupt the cartilaginous matrix.
Imaging Studies
Plain radiography
Plain radiography is the imaging method of choice because it is more cost-effective than other modalities and
because radiographs can be obtained more readily and quickly. One important characteristic of primary
osteoarthritis is that the abnormalities found in the load-bearing (ie, highly stressed) areas of the affected joint
differ from those found in the non–load-bearing areas. In the load-bearing areas, radiographs can depict joint-
space loss, as well as subchondral bony sclerosis and cyst formation.
Bone scanning
Bone scans may be helpful in the early diagnosis of osteoarthritis of the hand. Bone scans in osteoarthritis
typically yield a symmetrically patterned, very mildly increased uptake. In contrast, bone scans are often negative
in the early stages of multiple myeloma, a cause of bone pain in older adults that can be confused with
osteoarthritis. Bone scans also can help to differentiate osteoarthritis from osteomyelitis and bone metastases.
Magnetic Resonance Imaging and Computed tomography

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Magnetic resonance imaging (MRI) can depict many of the same characteristics of osteoarthritis that plain
radiography can, but it is not necessary in most patients with osteoarthritis, unless additional pathology amenable
to surgical repair is suspected. Pathology that can be seen on MRI includes joint narrowing, subchondral osseous
changes, and osteophytes. Unlike radiography, MRI can directly visualize articular cartilage and other joint
tissues (eg, meniscus, tendon, muscle, or effusion).
Computed tomography (CT) is rarely used in the diagnosis of primary osteoarthritis. However, it may be used in
the diagnosis of malalignment of the patellofemoral joint or of the foot and ankle joints.
Arthrocentesis
A diagnostic joint aspiration for synovial fluid analysis can help exclude inflammatory arthritis, infection, or crystal
arthropathy. The presence of noninflammatory joint fluid helps distinguish osteoarthritis from other causes of joint
pain. Other synovial fluid findings that aid in the differentiation of osteoarthritis from other conditions are negative
Gram stains and cultures, as well as the absence of crystals when fluid is viewed under a polarized microscope.

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