Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, which can lead to disability of joint system, associated with inflammation, swelling, and pain. [1][2][3] Recent studies suggest that activated inflammatory immune cells including T cells, DCs and macrophages that infiltrate into the joint synovium are responsible for the destruction of joint and cartilage. [4,5] Current agents (e.g., glucocorticoids and nonsteroidal anti-inflammatory agents) have been widely used in clinical applications for RA treatment. [6,7] However, the response to these therapies is very low, depending on the treatment history, especially the course of disease. In addition, strong side effects like teratogenicity, hepatotoxicity, and a high risk of infection limit the use of these agents with a high-frequent dose. [8,9] Therefore, new strategy that targets the affected tissues to enhance the efficacy of RA treatment is urgently awaited. Recently, cellular delivery systems have become a promising platform for therapeutics delivery. [10][11][12][13][14] Compared with traditional carriers, cell is an inherent component of the body with excellent biocompatibility. At the same time, different types of cells have their unique biological functions, such as chemotaxis, homing properties, immune regulation, and therapeutic effects, etc., which can be utilized to facilitate drug delivery. [15][16][17] We have previously found that platelet-derived extracellular vesicles (PEVs) which are naturally occurring nanoparticles released by platelets, can selectively target different sites of various inflammation, which is a kind of universal tool for inflammation diagnosis and treatment. [18,19] Berberine (BBR) is an alkaloid widely studied for the treatment of RA due to their anti-inflammation effect. [20,21] In preclinical studies, BBR has been proven by inhibiting inflammatory proliferation of macrophages and suppressing dendritic cells activation to inhibit inflammation of synovial joints, and by participating in a variety of inflammatory signaling cascades and apoptosis-mediated pathway to ameliorate RA. [22] Here, by loading BBR into PEVs, we showed that berberine-PEVs (BBR-PEVs) could inhibit inflammation by regulating the phenotype of macrophages and dendritic cells. In RA mouse model, high accumulation of BBR-PEVs in affected joints was observed following intravenously administration. Moreover, we found that the mobility of arthritis mice has significantly improved after BBR-PEVs treatment, and the infiltration of inflammatory cells at the arthritis site significantly reduced compared to the free drug treatment group at the same dose. In short, treatment based on our strategy can effectively enhance the efficacy of RA treatment with limited side effects (Figure 1a).