In a large skillet heat olive oil over medium high heat. Add sausage, onions, and garlic. Use a spatula to break up the sausage. Cook for 5-6 minutes until golden brown and cooked through. Drain any fat that is in the pan. Add the artichokes, and mix to combine.
In a 2 cup measuring cup combine half-and-half, butter, Parmesan cheese, black pepper, and red pepper flakes. Pour into sausage mixture. Heat until it starts to boil. Add cooked pasta and toss to combine. Season with additional salt and pepper if desired.
Serve immediately topped with additional Parmesan cheese if desired.