Narrative review explores exosomal non-coding RNAs in osteoarthritis pathogenesis and therapy

Osteoarthritis (OA) is increasingly recognized as a chronic low-grade inflammatory joint disorder characterized by progressive cartilage degeneration, synovial inflammation, subchondral bone remodeling, and disrupted intercellular communication. Growing evidence indicates that exosomal non-coding RNAs (ncRNAs), including microRNAs, long non-coding RNAs, and circular RNAs, are key regulators of the OA microenvironment. By mediating intercellular signal transfer among chondrocytes, synovial fibroblasts, macrophages, osteoblasts, and osteoclasts, exosomal ncRNAs influence inflammatory mediator production, immune cell polarization, extracellular matrix metabolism, and osteochondral homeostasis. These regulatory effects are closely associated with major signaling pathways, including NF-κB, PI3K/AKT/mTOR, MAPK, and inflammasome-related cascades. Beyond their mechanistic roles in disease progression, exosomal ncRNAs also show strong potential as minimally invasive biomarkers for OA diagnosis and staging, as well as therapeutic agents or delivery vehicles for targeted intervention. This review focuses on the mechanisms of exosomal ncRNAs in modulating the osteoarthritis inflammation microenvironment, highlighting the potential of exosomal ncRNAs in osteoarthritis diagnosis and the prospects for their use in osteoarthritis medicine.