Clay, for people with arthritis a click pen is better, they have a hard time when it comes to the twist tranny's. With the click pens, they can push the button by pressing it up against anything. With twist pens, they have to hold on to the pen with both hands to twist the refill out. My neighbor can't use a twist pen, she has arthritis in both hands. I had offered her many pens over the years, but, she'd never take one, finally I asked her why, and she told me about how hard it was to try to operate a twist pen. And that's when I started making click pens. She happilly accepted the first one I made. Another thing about pens for people with arthritis and their pens, is that mostly they like a medium thickness handle like a Sierra, Slimlines are to small for their hands.
Len