Objective To analyze the predictive value of micrornA-141 (miR-141), micrornA-146a (miR-146a) in the treatment of patients with rheumatoid arthritis. Methods A total of 176 patients with rheumatoid arthritis admitted to Erdos Central Hospital from October 2020 to October 2022 were included in the study group. According to different clinical analysis, the patients were divided into the active stage ［28 joint disease activity (DAS28) score ＞3.2 points) 104 cases］ and the remission stage (DAS 28 score ≤3.2 points) 72 cases. Patients were followed up for 3 months to observe the therapeutic effect. After 3 months of treatment, patients with DAS28 score ≤2.6 were classified as achieving clinical remission. According to the treatment results, patients were divided into the clinical remission (115 cases) and the clinical remission (61 cases), and 182 healthy subjects were selected as the control group during the same period. Clinical data of the subjects were retrospectively collected. The expression levels, laboratory indexes and inflammatory factors of miR-141 and miR-146a were compared between the two groups. The expression levels, laboratory indexes and inflammatory factors of miR-141 and miR-146a were compared between the active and remitting rheumatoid arthritis patients. The expression levels of miR-141 and miR-146a, laboratory indexes and inflammatory factors were compared in patients with and without clinical remission of rheumatoid arthritis. The Pearson correlation analysis was used to analyze the correlation between laboratory indicators, inflammatory factor and the expression levels of miR-141, miR-146a.Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of miR-141, miR-146a alone and in combination.Results The peripheral blood levels of miR-141 and miR-146a in the study group were higher than those of the control group, whole blood levels of sediment and serum level of rheumatoid factor (RF), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP) were higher than those of the control group (P＜0.05). Compared with the remission stage, the peripheral blood levels of miR-141 and miR-146a, score of DAS28, whole blood level of erythrocyte sediment and serum level of RF, TNF-α, IL-6, CRP were higher in the active stage (P＜0.05). Compared with patients with clinical remission, patients without clinical remission had higher peripheral blood levels of miR-141 and miR-146a in peripheral blood, score of DAS28, whole blood sediment level and serum level of RF, TNF-α, IL-6, CRP (P＜0.05). The results of Pearson correlation analysis showed that DAS28, ESR, RF, TNF-α, IL-6, CRP were positively correlated with miR-141, miR-146a (r=0.805, 0.536, 0.819, 0.713, r=0.612, 0.781, 0.852, 0.662, r=0.517, 0.647, 0.802, 0.504, P＜0.05). ROC curve was plotted to analyze the predictive value of single and combined detection of miR-141, miR-146a on treatment outcome, the combined detection was the highest, with area under the curve (AUC) of 0.890, sensitivity of 83.61% and specificity of 86.96%. Conclusion The expressions of miR-141, miR-146a are higher in patients with rheumatoid arthritis, which are closely related to the severity of the disease and the therapeutic effect, and are positively correlated with various disease activity indexes, inflammatory factor. combined detection can provide reference for the evaluation of the therapeutic effect and prognosis