Increased volume of synovial fluid (SF) with large amounts of immune cells is present in the joint cavity of many patients with rheumatoid arthritis (RA), syndrome of which can be controlled by TNF-α/JAK inhibitors. Here, we applied single-cell RNA sequencing (scRNA-seq) and subsequent validations to profile the cell components, and their crosstalk in SF from RA patients pre-/post-treated with adalimumab/tofacitinib. Although the proportion of pathogenic cells (e.g., SPP1+ macrophage and CXCL13+CD4+ T cell) were not decreased after treatment, several genes (e.g., SPP1 and STAT1), molecular pathways (e.g., JAK/STAT) and cell-cell communications were altered in drug-specific manner. Particularly, SPP1+ macrophage can increase the inflammatory response of fibroblast-like synoviocytes in vitro and exhibit the most prolific communications with CXCL13+CD4+ T cell, which are abolished after treatment and positively related to treatment efficacy. Our study establishes the correlation of the pathogenic SF cells with progression and treatment outcomes in RA.