Cook the pasta. Bring a large pot of salted water to a boil.
Cook the pasta until just shy of al dente. Reserve about 1/2 cup of pasta water, then drain.
Brown the sausage. In a large skillet over medium-high heat, sear the sliced sausage until browned on both sides, 4–6 minutes. Remove to a plate.
If the pan is dry, add the olive oil.
Sauté the vegetables. Add butter to the skillet. Toss in the onion and bell peppers with a pinch of salt. Cook, stirring, until softened and lightly caramelized at the edges, about 6–8 minutes.
Add garlic and spices. Stir in garlic, Cajun seasoning, smoked paprika, and red pepper flakes.
Cook 30–60 seconds until fragrant. Taste a bit of the veg to gauge heat and salt; adjust if needed.
Build the sauce. Stir in tomato paste and cook for 1 minute to caramelize slightly. Pour in chicken broth and scrape up any browned bits.
Simmer 2–3 minutes to reduce by about a third.
Make it creamy. Lower the heat and add heavy cream. Stir until the sauce turns a warm, rosy color. Simmer gently for 2 minutes to thicken slightly—don’t boil hard.
Add cheese and balance. Stir in Parmesan until melted.
Squeeze in lemon juice to brighten. Taste and season with salt and pepper. The sauce should be savory, a little spicy, and smooth.
Combine pasta and sausage. Return the sausage to the pan, then add the drained pasta.
Toss to coat. If the sauce seems thick, splash in reserved pasta water until glossy and clinging.
Finish and serve. Turn off the heat. Let it sit for a minute so the pasta absorbs some sauce.
Top with chopped parsley or green onions and extra Parmesan. Serve hot.