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Cook the penne in a large pot of salted water according to the package directions. Reserve 1 cup of the cooking water then drain the pot.
Add the sausage, onion, and garlic to a large frying pan over medium-high heat. Cook, crumbling the sausages with a spoon, until the sausages are cooked, about 6-7 minutes.
Add the tomato paste to the pan and stir it into the sausages. Let it caramelize for 2-3 minutes then add the wine or stock to deglaze the pan, scraping the bottom to release any flavorful bits that are stuck on.
Add the crushed tomatoes and cream cheese and simmer the sauce, stirring a few times, until the cream cheese has melted. Season to taste with salt and pepper.
Add the cooked penne and spinach and stir them into the sauce. Add a little of the reserved cooking water to loosen the sauce, if needed.