Over a ten year period five patients developed aplastic anemia in association with gold therapy for rheumatoid arthritis. None of these patients was suitable for bone marrow transplantation due to the lack of a compatible sibling. Four patients with severe aplastic anemia died, despite intensive haemopoietic support and trials of gold chelating agents. Survival ranged from 22 to 103 days (mean 55 days) with death in each case being due to a combination of bleeding and infection. The remaining patient with moderate aplasia survived, recovering over a period of two to three years.