Therapeutic gold. Is it due for a come-back?

The historical use of metallic gold and gold complexes in medicine is briefly outlined. Currently, there is a large body of opinion that they belong to another age, are no longer relevant and that there are more-than-adequate successors to replace them. Nevertheless some challenging questions remain: (1) Should we now ignore their remarkable properties for ameliorating rheumatoid arthritis, even inducing remissions and for preventing arthritis development in animals? (i) What mechanisms underlie their clinical activity? (ii) Can some of the adverse effects of traditional therapy with gold-thiolate complexes be reduced/prevented by either modifying their formulations, or by using some of their bio-transformation products at much lower doses? (iii) Are they equivalent, perhaps even superior to biological DMARDs (anti-TNFalpha, anti-IL-1), and if so, more cost effective?