Osteoarthritis(OA) is a common degenerative joint disease characterized by cartilage degeneration, synovial inflammation, osteophyte formation, and joint space narrowing, seriously impairing patients' mobility and quality of life. The pathogenesis of OA is highly complex, involving multiple cell types and signaling pathways. Key pathological processes include abnormal chondrocyte function, sustained activation of inflammatory responses, and imbalances in apoptosis and autophagy. In recent years, microRNAs(miRNAs), small non-coding RNAs, have been recognized for their crucial roles in regulating gene expression and influencing the progression of various diseases. miRNAs exhibit important regulatory functions in OA-related processes such as inflammatory regulation, chondrocyte apoptosis and autophagy, extracellular matrix metabolism, and subchondral bone remodeling. Multiple specific miRNAs have been shown to be closely associated with the onset and progression of OA, demonstrating potential diagnostic and therapeutic value. Traditional Chinese medicine(TCM) is an important treatment approach for OA, offering advantages such as multi-component, multi-target, and multi-pathway regulation. Recent studies have shown that TCM single herbs, compound prescriptions, acupuncture, and moxibustion can upregulate or downregulate the expression of specific miRNAs, thereby intervening in their downstream target genes and related signaling pathways. This leads to anti-inflammatory and analgesic effects, inhibition of chondrocyte apoptosis, promotion of matrix synthesis, and cartilage repair. This review systematically summarizes the mechanisms of miRNAs in the progression of OA, with a focus on the latest research advances in TCM regulation of miRNAs to intervene in OA. The aim is to provide a theoretical basis and new insights for the early molecular diagnosis, targeted therapy, and modern research and clinical translation of TCM in OA.
