Drugs for the effective treatment of rheumatoid arthritis (RA) are currently lacking. While there is growing interest in the potential application of mesenchymal stem cells (MSCs) in the treatment of RA, there are potential risks associated with cell-based therapies. MSCs secrete functional exosomes (MSC-Exos) that can mediate many of the functions of MSCs and, consequently, these extracellular vesicles provide an attractrive alternative that may circumvent many of the risks associated with cell-based strategies. With current advances in exosomal technology, including on-going studies in animal models and findings from large-scale clinical trials, there is great expectation that MSC-Exos will provide a new and exciting strategy for the treatment of RA.