Regenerative and Stem Cell-Based Therapies for Arthritis: Harnessing Mesenchymal Stem Cells, Exosomes, and Bioengineered Scaffolds for Functional Joint Repair.

Arthritis, encompassing degenerative disorders such as osteoarthritis (OA) and autoimmune diseases like rheumatoid arthritis (RA), remains a leading cause of chronic pain, disability, and socioeconomic burden worldwide. Conventional pharmacological and surgical therapies primarily offer symptomatic relief without addressing the underlying degeneration of cartilage and bone. Recent advances in regenerative medicine have introduced promising biological strategies, particularly mesenchymal stem cells, exosomes, and bioengineered tissue scaffolds, for functional joint restoration. MSCs exhibit remarkable differentiation potential, along with immunomodulatory and paracrine effects that support cartilage repair and immune homeostasis. MSC-derived exosomes replicate many of these therapeutic functions through their bioactive cargo of proteins, lipids, and microRNAs, offering a safer and more controllable cell-free alternative. Meanwhile, bioengineered scaffolds composed of natural or synthetic polymers provide essential structural and biochemical cues for tissue regeneration, especially when integrated with stem cells or exosomes. Despite encouraging preclinical and early clinical outcomes, challenges remain concerning safety, standardization, scalability, and regulatory approval. The integration of emerging technologies such as nanotechnology, artificial intelligence, and gene editing may further enhance regenerative outcomes and enable personalized arthritis therapies. Collectively, these convergent innovations represent a paradigm shift from symptomatic management toward true biological repair, positioning regenerative and stem cell-based therapies at the forefront of next-generation arthritis treatment.