Abnormal T follicular helper (Tfh) cells in patients with rheumatoid arthritis (RA) is related to the occurrence and development of RA. At present, the mechanism of Tfh cells regulating RA is still unclear. In addition, Tfh cell surface molecules C-X-C motif chemokine receptor 5 (CXCR5), inducible costimulatory molecule (ICOS) and programmed death factor 1 (PD-1) and its secreted interleukin 21 (IL-21), B-cell lymphoma 6 (BCL6) have been shown to be involved in the development of RA. We mainly reviewied the mechanism of RA regulation from the perspective of Tfh cell surface molecules and their secreted factors, analyzed the effects of various molecules related to Tfh cells on RA, and explored the significance of each molecule in the clinical diagnosis of RA and the potential ways of treating RA with each molecule as a target.