Patients with early rheumatoid arthritis (RA) were randomly divided into those receiving gold early (n = 13) or 6 months later (n = 10). They were followed 6 monthly over 18 months. Mean erosion area in gold and delayed gold, measured from macroradiographs, was comparable at baseline and increased significantly over the first 6 months. In the second 6 months, gold showed no increase and delayed gold an insignificant increase. By the third 6 months both groups showed a decrease. On comparing the second 6 months of gold therapy in gold and delayed gold with a group of patients with RA of similar disease duration (n = 34) not receiving gold, a lower proportion (p < 0.005) had erosion area progression and a higher proportion (p < 0.001) erosion repair.