The clinical course of disseminated coccidioidomycosis is highly variable. Neither spontaneous cure nor spontaneous ankylosis has ever been demonstrated in an adult with the disease in one or more disseminated articular foci. Coccidioidomycotic arthritis may fluctuate in activity, and may be compatible with years of limited function and moderate morbidity. Amputation as well as arthrodesis accompanied by adequate excision of diseased tissue are generally reliable methods of treatment of infected joints, but the decision whether or not to "cover" such patients with systemic doses of amphotericin is still difficult, and the roles of synovectomy and topical amphotericin remain to be determined.