Bring a 6-quart / 5.7L pot of water to a boil and salt it generously.
Heat the olive oil in a 12-inch / 30cm skillet over medium heat. Add the crumbled sausage and cook, breaking it up with a wooden spoon, for 6 to 8 minutes until browned.
Add the shallot and garlic to the skillet. Cook for 3 to 4 minutes until softened and translucent.
Pour in the white wine, scraping up any browned bits from the pan. Simmer for 2 to 3 minutes until mostly evaporated.
Drop the pasta into the boiling water and cook until al dente, about 10 to 12 minutes for rigatoni. Reserve 1 cup of pasta water, then drain.
Lower the heat under the sausage and pull the skillet off the burner for a few seconds. Stir in the cream, then return to low heat and simmer gently for 2 minutes, without letting it boil hard.
Add the drained pasta to the skillet and toss to coat. Splash in reserved pasta water a little at a time if the sauce looks too thick.
Take the skillet off the heat and stir in the pecorino and black pepper, tossing until the sauce turns glossy and coats the pasta.
Plate immediately, topping with extra pecorino and a few shavings of black truffle if using.