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Cook sausage in a large saucepan or Dutch oven over medium heat, breaking it up as it cooks, until it is no longer pink, 2 to 3 minutes. Add onion and cook, stirring frequently, until soft and translucent, about 5 minutes.
Increase heat to high; add okra, tomatoes, tomato juice (or water), salt and crushed red pepper (or jalapeno) and cook, stirring often, until bubbling. Reduce heat to a gentle simmer and cook, stirring occasionally, until the mixture is thick and the vegetables are very tender, 35 to 45 minutes.