Osteoarthritis (OA) is a chronic bone and joint disease characterized by gradual degeneration of joints, which seriously affects people's health and quality of life. However, the pathogenesis of OA is not clear. At present, the clinical treatment of OA is mainly oral drugs treatment, intra-articular drug injection and surgical treatment, but they have obvious adverse reaction. Therefore, it is particularly urgent to explore effective treatment options. With the recognition of the therapeutic effect of traditional Chinese medicine (TCM), the active ingredients of TCM have been widely used in basic research and clinical treatment of OA. Based on this, the review sorts out the pathogenesis of OA and the research on the small molecule treatment of TCM, and reveals the therapeutic mechanism of active ingredients in TCM on OA from the aspects of regulating chondrocyte apoptosis, inflammation, extracellular matrix degradation, oxidative stress, macrophage polarization, ferroptosis, etc., in order to provide reference for treatment of OA with TCM and the research and development of related drugs.

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