Five randomized controlled trials comprising of 424 patients with osteoarthritis, predominantly knee osteoarthritis (OA), were all conducted in China. Bulleyaconitine A was administered either alone or in combination with other therapies, and compared with diclofenac, hyaluronic acid injections, or traditional Chinese medicine. Primary outcomes included effective rate, pain measured by VAS at 4 weeks, knee joint function scores (WOMAC, Lysholm score, Lequesne score, or traditional Chinese medicine (TCM) quantitative scales), and adverse events. Overall, the results showed that bulleyaconitine A achieved similar clinical efficacy and pain relief compared with control treatments, while demonstrating significantly greater improvements in joint function and a lower incidence of adverse events. These findings suggest that bulleyaconitine A may represent a safer alternative or adjunct to conventional pharmacologic therapies for osteoarthritis, although evidence quality remains limited.