Mesenchymal stem cells (MSCs), one of the most significant categories of stem cells, have garnered considerable attention for their potential in disease treatment due to their unique regenerative properties. MSCs can modulate immune responses through various mechanisms, including the secretion of anti-inflammatory cytokines like IL-10, TGF-β, and extracellular vesicles such as exosomes. The immunomodulatory properties of exosomes have led to their use in treating multiple autoimmune diseases, including rheumatoid arthritis (RA), a common inflammatory joint disease worldwide. Patients with RA experience chronic joint pain, movement disorders, joint and cartilage deformities, and significant treatment costs. The primary treatments for RA consist of pharmacological, non-pharmacological, and surgical methods, which mainly focus on alleviating symptoms and relieving pain rather than offering a complete cure for the disease. Recent clinical trials suggest that cell therapy along with exosome therapy, may be a promising and effective treatment option. Exosomes possess unique features that enable them to transport a variety of medicinal and biological compounds, as well as secrete anti-inflammatory substances and growth factors. Thus, exosomes can help reduce inflammation and pain in patients with rheumatoid arthritis while promoting joint repair and regeneration. In this review, we discuss the remarkable therapeutic effects of MSC-derived exosomes in reducing inflammation, facilitating joint repair, and providing pain relief in RA patients. We also detail the characteristics of MSC-derived exosomes, their isolation techniques, and the pathways of their secretion.