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It is easy - but not practical - to believe that life can continue in the same way for rheumatoid arthritis sufferers as it did before the onset of the disease. That is not to say that rheumatoid arthritis should be seen as a crisis or disaster, but should be recognized as a real situation which needs to be coped with through certain adaptations. The whole organization of the patient's daily life must be rethought. Living conditions can be designed to make life much easier for the sufferer.

The occupational therapist from the hospital has received special training in this field, so it may help patients with arthritis to go and chat with the occupational therapist about their own particular problems. The occupational therapist may well want to visit the home with the patient to see actually what difficulties may be encountered, before he or she makes useful and helpful suggestions.

The kitchen, for example, is often poorly designed, forcing the poor housewife to walk many unnecessary miles during the day whilst carrying saucepans between the sink and the stove, and food between work surfaces and the larder. Simple rearrangement of the kitchen can help her considerably. For instance, the cooker should be next to a working surface or draining board near to the sink, so that the housewife, if she has a heavy saucepan to empty, can slide it straight across from the cooker without having to lift it physically.

There is a wide variety of specially designed cooking utensils for patients with arthritic problems. For instance, if the patient has difficulty holding an ordinary knife because her fingers will not bend sufficiently to grip, then a knife with a specially fat handle may be the answer.

The lavatory can also be a problem. Patients with severe hip or knee diseases may have difficulty in getting on and off it. A simple grab rail and an adaptation to the bowl to give it a high seat may improve the situation. Another exasperating factor is that quite often the lavatory is virtually inaccessible, being up one or two flights of stairs which the patient finds impossible to climb. Today, there are several models of completely hygienic and aesthetically acceptable chemical commodes, which can be wheeled to the patient and then stored away without any unpleasantness. A severely crippled patient may have great difficulty with personal hygiene after using the lavatory. For them, a bidet with a spray followed by warm air for drying can be supplied. Likewise, specially designed

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