Abstract Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent joint inflammation and pain. Conventional systemic therapies, typically administered orally or by injection, often result in gastrointestinal side effects and poor patient compliance. Although microneedles (MN) enable localized and minimally invasive drug delivery through the skin, their therapeutic efficacy remains limited by uncontrollable and unpredictable release kinetics. Here, this work reports a wearable electro‐controlled MN device (EMND) for synergistic RA therapy. The EMND mainly consists of a MN array, a conductive hydrogel, a miniature control circuit and a smartphone‐based application. The MN array facilitates transdermal access at the lesion site, while the conductive hydrogel enables electrically triggered, on‐demand drug release via iontophoresis. This design allows precise spatiotemporal control of multiple therapeutics to achieve synergistic anti‐inflammatory and analgesic effects. In RA rat models, EMND treatment reduced inflammatory cytokine levels to 11.38%–14.51% of baseline and increased pain thresholds by 5.24‐fold. Overall, this wearable EMND offers an exciting prospect for facilitating RA treatments and autonomy of therapeutic interventions, with potential applications for other chronic conditions.