Joonas is a Finnish enduro rider with a more than a decade of high-level riding under his belt. For the past couple of years enduro riding has been the main focus for Joonas, although his competition experience reaches all the way to the World Cup downhill events. Well before that, his resume included several podium finishes in the national enduro and XC youth cups. What makes Joonas and his situation unique and a story worth telling are the challenges he has to tackle on a daily basis. To get the full picture, it's best to start from the beginning.
Who is Joonas Riihelä?
• Nationality: Finnish
• Age: 28 years
• Riding experience: 13 years
• Most notable results: 2nd in National Enduro Youth Series in 2006, 1st in National Enduro Youth Series in 2007, 3rd in National XC Youth Series in 2007, 6th in National level Downhill Series in 2011 and 4th in National Enduro Series in 2016.
• Interestes besides riding: Videography, car simulator games
• Sponsors: Pole Bicycles
• Favorite food: Hamburgers, of course!
From a Kid on a Bike to an XC RacerAs for many of us, Joonas swung a leg over a bike when he was a young kid. His bike was his vehicle for freedom and speed which had been untapped until then. Eventually, Joonas knew his local trails as well as, or even better than his backyard. The sections that provided even just a little bit of airtime in the form of a banked stone or even a built jump or lip were known to the millimeter.
One thing led to another and in 2005 Joonas spent (or invested, depending on how you want to see things) his hard-earned summer job money on a proper mountain bike. Soon after he entered a national level XC race in Lahti, called Finlandia MTB. A spark burst into a full-sized flame next year in the form of XC racing and early forms of enduro riding. Interestingly, mountain bike enduro was most likely born in Finland although the format was slightly different than it's today. Slightly might be a bit modest term, since most of the races were held on flat(ish) tracks and the segments could be as long as 10km! Pacing strategy was naturally the same as today; start all out and hang on to your dear life and hope that the finish line arrives before you run completely out of steam. If the old format would have remained unchanged, it might be that enduro would not be as popular as it is today but that's a subject of a whole another conversation. With a combination of the limitless energy that adolescent boys have and pure hard work, Joonas earned the national champion title in the XC youth category in 2007.
Gravitational EnlightenmentSoon after things took a turn which is most likely not too unfamiliar to most of us. XC started to feel boring, even a bit dumb. Why pedal your arse off and turn yourself inside out when even more thrilling speeds can be reached with the help of good ol' gravity? Joonas raced downhill first time during 2008 and soon enough XC bike started to gather dust in the corner of the garage. This set the tone for the things to come; bikes equipped with a chainguide were in and ones with front derailleur were definitely out.
The time between 2010 and 2011 was especially prolific and Joonas gained a lot of pure race pace speed. In his own words: “I made very good progress and made a clear leap to the next level when it comes to track speed and bike control.” The recipe for this was simply hard work and plenty of time on the bike. During the winter months in 2011, Joonas rode several times a week with a friend who was considerably faster than him. It's no secret that it's one of the best ways to develop as a rider. According to the saying, you either rise or fall to the level of your peers, no matter the domain. It's also worth noting that riding during the winter time was no easy task. To get a session in, it more often than not required shoveling the track clear from snow. This effectively doubled the amount of time that was needed for riding. To ride couple of hours, snow shovel was put in good use for at least the same amount of time. No dig, no ride, no matter if it's about dirt or white stuff that falls from the sky during the winter months in the northern hemisphere.
Joonas raced with panache during 2011 season. Calpalinna (a legendary bike park for us Finns) hosted the first race of the season. A good run during the qualification resulted in the fastest time of the day which was big confidence booster. Things got even sweeter later in the evening when Joonas received a text from a rider who he had always looked up to saying: “I suppose that there's a storm brewing when it comes to your riding.” Podium finishes were not to be during that season however. Small mistakes during race runs, bike and equipment related problems meant that placings from 4-6th were a common occurrence in national cup races. The season wasn't limited only to domestic races though. Joonas gathered plenty of vertical meters abroad in the iXS cup and even downhill world cup races held in Leogang and Val di Sole.
When Crap Hits the FanA promising season was ended with a seriously low tune. At the beginning of 2012, Joonas started to suffer from gastric refluxes and severe stomach pains, which resulted in extensive examinations and hospital stay. The first suspected diagnosis was lymphoma which – luckily enough – was turned out to be false soon after. One of the symptoms was heavily swollen spleen which is dangerous since even a slight impact can cause it to burst. Unfortunately, any sports that involved high speeds and the accelerating effect of gravity were out of the question.
Slowly and steadily Joonas started to feel better after the initial symptoms. Anyone who knows Joonas will attest that he is not a one to sit still and fall into despair. Since he could not ride, he needed a new outlet for the time and energy he had on his disposal. While recovering he decided to build a house – an obvious choice for any 22-year old. The courage to tackle a project of that scale is something to wonder, since a typical mountain bike is most likely still eating dirt in the playground that age. Skipping forward a full year and plenty of eventful times, the house was ready. Exactly one month after the house was finished, his left knee got badly swollen which was soon after followed by similar symptoms on the other knee as well. Off to the hospital he went for a new set of examinations.
A New NemesisThe symptoms in the knees quickly spiraled to almost full body level. Both knees, ankles and the right shoulder got inflamed and except for the shoulder, got heavily swollen by unexplained liquid retention. A doctor in the rheumatology department diagnosed the condition as psoriatic arthritis, which is an autoimmune disease with unknown cause. Looking back, Joonas suspects that the house project could have been too much because of the stress it caused. We continuously learn about the negative effects of chronic stress and its possible unwanted effects to all sorts of health problems. Even though Joonas is made of stuff that you rarely see these days, he says that the house project was stressful at times. This can be translated without a doubt, that it would have brought a lesser man to his knees several times.
The condition was first treated with cortisone injections, which provided some relief. Although the injections dulled the pain somewhat, this type of treatment comes with its own set of problems and less than desired side-effects. Cortisone can weaken the tissues where it is injected to and make them fragile. There are rumors that some former professional road cyclist had to pay dearly after their career because of “generous” use of this particular substance. To sum it up, cortisone treatments weren't the answer, just a short-term fix for the symptoms.
Treatment of arthritis includes always a long and tedious testing to find the right treatment. Last resort is usually a new type of biological medicine, which are called biologics for short. They're often times effective in pain relief and they can go a long way in restoring patient's function. Is there a downside? Yes, a hefty price tag which will make mountain biking seem like a cheap sport in comparison. Costs of treating arthritis with biologics can rise up to 20,000 EUR per year. Luckily Finnish national health care covers most of the financial burden, but it goes without saying that all other paths and options are tried first.
The battle with the newfound disease continued all the way up to 2016. It is worth noting that the word battle isn't used lightly here since the disease made even everyday tasks a challenge at times. Think of an occasion when you hit your knee and it was sore the following morning, so sore that flexing it caused pain. This was and still is the situation that Joonas encounters every morning. He needs to make the steps from the bedroom to downstairs with a straight leg since the knee is always stiff after overnight immobility. Eventually it and the rest of the body warms and loosens up as the day progresses. Not the most pleasant way to start the day, but you gotta make the most of it, as Joonas says.
Back on the BikeAs it often times happens, a turn for the better came in a form of a friend. A long-time friend was interested of trying his hand at riding and asked Joonas if he could provide some guidance. Recognizing the limitations of his situations, Joonas still agreed. A substantial factor in his decision was that he could be in similar state 10 years from now, whether he rides or not. Why not to make the best of times ahead? Joonas started riding with his friend during the winter of 2016 and 2017 and as one could guess, enjoyed his time on the bike immensely. Although the speed wasn't at the level where it used to be, riding was fun and rewarding. Anyone who has had a long unwanted lay-off from the can surely attest to this.
In the beginning of 2017, Joonas made the decision to race again. He went back to the roots in a way since the chosen discipline was enduro. Much had changed in ten years though since the original debut in the sport (and for the better, one could argue). Although the races are still physically demanding, they don't make yourself question the fun of doing it in the middle of the race several times a minute. Joonas set himself a goal of finishing in the top 30, got into structured training and tackled the challenge. The end result was more than a positive surprise – he finished 4th in the national series by the end of the year! This is a no small feat considering that he had been off his bike for two years, still dealing with the medical condition and modifying his training heavily around it.
In the middle of the 2017 season, Joonas tried the Evolink from Pole Bicycles for couple of laps in his local bike park. Being 189cm tall, he's always been challenged by finding a proper sized bike. This time the match was as good as the contact between a proper pair of flats pedals and the sticky soles of 5.10's. When the Evolink came out, some were questioning the sizing and if even the L-size was just too big of a bike. Nowadays Joonas rides happily an XL-sized frame and the results speak for themselves that he has the right tool for the job. It is no exaggeration to say that Joonas can ride a hard packed berm faster than anyone else in the country. A proof of this was a comment from a former professional downhill rider who said that it was plain scary to follow Joonas on tracks of this type.
Last runs of 2018 before Sappee Bike Park got its snowy cover. Taking It Day by DayEarly last year Joonas made an extended trip to Spain. Riding felt fast, and most importantly good and confident. Unfortunately, from the beginning of the two months stay In Malaga with his girlfriend, the troubled knee started acting up again. Inflammation in the knee escalated so badly that Joonas was unable to ride any trails or segments that included pedaling. At this point the knee in question was the source of most the troubles. It needed to be drained regularly to keep it in somewhat working condition. Doing this once in every 2-3 weeks in Finland was an ordeal itself and proved next to impossible abroad. Nevertheless, Joonas made most of his stay in sunny Spain while other Finnish riders were plowing snow from their home trails, or just staying inside to avoid the frigid temperatures.
“If I want to race during the weekend, I need to get the knee drained around Tuesday and hope for the best”, Joonas says. Getting scheduled appointments from a skilled doctor is next to impossible which leaves the private sector the only option. To keep himself competitive, Joonas needs to do quite a bit more than just training and his bike in a working condition. He's not the one to complain though, on the contrary.
Costs of getting the knee drained are equal to getting the suspension fully serviced. Doing that several times a month gets on top of just about anyone's wallet.
Many people and close friends have asked how Joonas can ride even when he can't walk around couple of blocks. To this Joonas replies that riding downhill is surprisingly static and you can get away with very little lower body movement when the gradient is favorable. There's an inherent risk though, especially if a crash occurs. Joonas hasn't been able to flex the problem-causing knee past 90 degrees for a long time and he's dreading about the thought what happens if it's forced past that range of motion during a crash. Yes, riding always carries inherent risks, but at the moment Joonas is rolling with an increased risk factor.
It's best to take things day by day and be grateful for everything.—Joonas |  |
On same rare occasions, Joonas might wake up without any considerable pains which makes him feel that he could jump straight up and run a marathon. Of course, he hasn't done any silliness like that, since every bike rider knows that running is acceptable only if being chased (and only with the speed that prevents being captured). At the moment Joonas is waiting in line to get a surgery on his knee. It needs to be cleaned up after the constant and ongoing inflammation. Things are not this simple though. Joonas caught whooping cough that lasted almost 3 months because of the changes in medication that made his immune system temporarily weaker. To get as high a probability for success as possible, he has to be 100 % healthy when getting to the operating table.
If all goes well, we might see Joonas in the Finnish national enduro race circuit in 2019. Give him a thumbs up and a kind word. Although Joonas is not a one to give up, it will make a difference. This is true for anyone who is battling with a serious health issue.
Clinical and epidemiologic evidence as well as data from experimental animals demonstrate that a tendency to develop autoimmune disease is inherited. This tendency may be large or small depending on the disease but, in general, close relatives are more likely to develop the same or a related autoimmune disease. A number or genes have been implicated in causing autoimmune disease, primarily genes related to the human major histocompatibility complex called HLA.
Please people. I am glad that your vegan or carnivore diet "cured" your autoimmune disease. But "data" is not the plural of "anecdote". Many autoimmune diseases are known to involve a genetic predisposition and a trigger event. If I don't have the predisposition I am very unlikely to have the disease. Many of the comments here remind me of the number of people who blame stomach ulcers on "stress" instead of h. pylori bacteria.
Under the direction of one physician I tried a truly horrid "migraine trigger elimination diet". Two months of can't eat this or that or anything with flavor. No change whatsoever. A couple $100K later we found evidence of permanent damage from a TBI I received when I banged my head on a low hanging beam walking down a staircase.
My wife has had two autoimmune diseases. The first responded to surgical treatment which eliminated the symptoms. The second was Rheumatoid Arthritis.
Ultimately she was treated with a biologic and her Rheumatoid Arthritis went into remission. We went down that route because 80% of the patients treated with that biologic have damage reversal, and 30% go into remission. She was in the latter category. So every winter we plan where we will take our on/off road tandem bike adventure instead of wondering if this will be the year she can't pick up a fork to feed herself.
The biologic in question is hideously expensive. We paid 1/3rd out of pocket. I actually had one insurance company tell me that they would not pay for it because it was "not medically necessary". My response was to tell them to pay by the end of the day or I would get a cop and place their CEO under arrest for practicing medicine without a license. We will never know how that would have gone because they backed down.
Please don't tell me that this shows the need for a single payer system in the USA. Joonas Riihelä lives in a country with a single payer system, and reading between the lines, he is not yet getting biologics to treat his condition. They are expensive to develop and to manufacture. All 3rd party payer systems need to control costs. Telling someone with RA or PA "sucks to be you" is cheap. Biologics are expensive.
I wish nothing but the best outcome to anyone dealing with an auto immune disease. Hopefully your outcome will be as good as my wife experienced.
Let me answer to these couple things some of you wondered
- I have tried different diets to help my condition, none have made a big difference, but I have stayed on a vegetarian diet and also try to avoid excess sugar
- I am already taking biological medication (3rd one going since the first two didn't work)
I'm a bit lazy to post anything here, but if you want see what I'm up to, feel free to follow me on Instagram @joonasriihela
Yes, I agree @samimerilohi I've had RA for ten years now and I've had countless (unasked for) advice from so many people: what to eat/not eat, what to drink/not drink, what to wear/not wear, things to rub on my skin, how to move/not move and the list goes on.. it's probably all well meaning but it gets soooo tiring. Especially when it's from people who are not doctors or not even ill themselves, but have just heard/read something somewhere.
Johns Hopkins states that autoimmune diseases result from a combination of genetic risk factors and an "environmental contribution." The biologics (hopefully) address the genetic component but diet and lifestyle changes can help the environmental side of the equation.
"Common threads uniting the autoimmune diseases are the presence of an autoimmune response based on cumulative genetic risk factors, combined with an environmental contribution (infectious, chemical, physical, or other)."
Source: autoimmune.pathology.jhmi.edu/whatis_approach.cfm
There is plenty of peer-reviewed data out there to support the benefits of gluten-free, dairy-free, Mediterranean diet, probiotics, fasting, stress-management, meditation, yoga and even fecal transplants. Some of the more extreme diets like Keto, Paleo and no-nightshade work for other people at n=1 levels. It's possible to incorporate diet and lifestyle changes as methodically as we change our training routines and stick with the changes that work for us. I hope his latest round of biologics work, but I hope that Joonas keeps an open mind and keeps experimenting with his lifestyle factors to optimize his own health.
My point in citing JHU's page was to get people to look at it. I am glad you did. Yes, there are triggers to autoimmune diseases. But I stand by my point: absent genetic predisposition you are not very likely to develop a particular disease.
If you have celiac disease by all means go on a gluten free diet. Or if you have an allergic reaction to other proteins in wheat. Or if it makes you feel good. What I am saying is that pushing this or that or the other for someone's issues which are rooted in autoimmune disease is very likely to be counter productive.
Diet can be invaluable. Type I diabetics can greatly reduce the complications of diabetes by controlling their diet, and people with a family history of Type I should consider a low sugar, low carbohydrate diet. I don't know of a single relative with diabetes. I doubt it would help me avoid a disease I have a very low probability of developing.
Not meaning to be harsh, but placebos work very well. I think bike riding for more than an hour daily makes my head stop hurting. Once I have daylight after work, I try to ride for an hour or more. Is it relaxing? Maybe or maybe not the way I ride. Is it placebo? I don't care. It works for me.
Is there science to support my feelings? Yes. But I do it because it makes me feel better, not because someone said it might help. And until recently we didn't know of any reason why it would help. Sometimes science has to catch up with reality.
I don't recommend it to relieve anyone else's migraine symptoms. It has helped me get back to what I weighed when I graduated from High School 40+ years ago, and there is very good evidence supporting the idea that that is a good thing.
I went to a shrink and learned meditation techniques to deal with chronic pain from my head injury. I am lucky. I can do it. Not everyone can. But if I can't meditate myself to sleep or restfulness, there are drugs.
I eat a Mediterranean diet because... because I grew up on it. Is it healthy? If I don't eat too much, maybe yes.
And, yes I am saying that stress is overrated. I like adrenaline. I work at a job that is generally thought of as high stress. I spent 10 years as a volunteer firefighter. I built my own house while working full time. No autoimmune disease. I picked very good parents.
- stem cells with PRP @ $5000 for 2 joints
- PRP injections into 1 shoulder @ $1100
- Biocartilage injected into my left shoulder @ $4500
Just curious what Biologic you got, and the cost...
But there is a crap ton of controversy around certain fruits and veggies. Take a look at FODMAP, GAPS, and the new Plant Paradox book to name a few.
There's no way of knowing who to trust these days. But if you're suffering from health issues, you've got to start somewhere and be willing to experiment.
Good luck on your season Joonas, thanks for the inspiration to stay on the bike!
Done so for last 8 years and had a lot of ups and downs but glad I stuck to riding as it’s helped me in the fight with this disease
I was diagnosed with osteoporosis and when I had my last scan it was near enough gone
I had read that cycling promoted bone density and the doctor actually asked why I was at her clinic when she said she couldn’t see any signs
She checked my records and seen it had previously been found and was intrigued with the results
Now off all meds after stoma surgery and never looked back????????????????
Causes of these diseases are mostly unknown. Genetics may be a part, and diet could be as well. However there are few reliable studies showing real impact of diet changes, the information you find is mostly anecdotal. A change in diet also has a placebo affect, which makes things more difficult. In my case fiber-rich food, lean meat (steaks!) and probiotics seem to have a positive impact, but I could be imagining that. ;-)
I am very thankful for our good public health care system here in Austria. My doctor tried cortisone first, but it did not help, and then we went directly to the biologics mentioned in the article, which work very well, and the public insurance is paying without complaints. With the biologics I have almost no symptoms at all and can live a normal life.
great article! love reading all the comments as well from people who can relate
I’ve got ankylosing spondylitis and it took my the best part of ten years to diagnose and another five to get it under control. Sometimes when it’s bad it’s incredibly painful even trying to get onto a bike, but exercise is important in keeping it under control and each ride makes me feel better by the end.
I see a lot of comments on the cost of the biologics here and I happen to have worked for big phama in that area. What a lot of people don't know is how expensive it is to get something on the market. The last figure I heard was that to get a biologic from the idea to the FDA approved finish line was a cost of 1.4 billion dollars. Less than 5% of the biologics that are started in the process make it to the finish line. The money to do these projects is usually raised from investors who expect a payoff for their investment. Dealing with the FDA is an expensive and labor intensive process. And a lot of times the number of people that the biologic will be administered to is pretty low compared to a condition that is more common and the scale of the production helps cut costs. Also, actually manufacturing the biologics is an expensive process. Mammalian celled biologics is a costly way of doing things but so far it is the only way to make these therapies.
I currently work for a plant based biologics company that should be a lower cost per dose because the process is cheaper.
And no, Shawn Baker etc. dont count.
You insults only show the emptiness of your arguments or lack there of. Please, all I'm asking is spend some time to put your knowledge to the test by doing some research into the matter. That's what I did and I had to follow the evidence where it led me.
www.greenmedinfo.com/disease/rheumatoid-arthritis