Abstract Rheumatoid arthritis (RA) is a multifactorial autoimmune disease primarily characterized by erosive arthritis. It can lead to joint pain, swelling, and deformity, significantly affecting patients' quality of life. RA results from the interaction of multiple factors, including genetic, environmental, and immune components, and its pathogenesis has not yet been fully elucidated. Existing treatment regimens have several limitations. Mesenchymal stromal cell (MSC) therapy has shown promising therapeutic potential in both preclinical and clinical studies due to its unique biological properties, such as multi‐lineage differentiation potential, immunomodulatory functions, low immunogenicity, and strong tissue repair capacity. This article provides a comprehensive review of the long‐term efficacy, safety, and potential mechanisms underlying MSC therapy on RA, with the aim of proposing MSC‐based strategies to optimize therapeutic outcomes.