The first thing I would do is cut your TLOD and OLOD back to 100 each (that can be fine tuned later) and see how you like it. The larger LOD’s make things look better at a distance, but it becomes a point of diminishing returns. Clouds I would set to medium. Raymarched reflections could to be cut back a notch, but I’ve found the performance hit to be minimal. I think I heard the glass cockpit refresh rate also hits the CPU a fair bit and there is negligible difference between medium and high. If you don’t use them much, you can cut it to low for more of a boost at the expense of slower updating of the cockpit screen.
Give that a shot and see how it goes. I would park at a busy major airport and see what your main thread times are (not so much for fps). Pick a weather preset and a set time instead of real world weather and time. This way you can repeat this test with similar conditions. It would be good if you can get your CPU frame times under 20ms, great if under 15ms if you don’t mind the reduced settings necessary for it.
Once that is done, you’ll probably see some improvement in the gpu frame times as well, resulting in higher fps. If you are happy at this point, I would turn v-sync on in the game settings and limit it to 30 fps. This will give you pretty smooth performance with minimal stutters. If you want to aim for higher frame rates, you’ll then have to either turn other graphical settings down or reduce the render scale. I have a 6600 XT that I use to run a 27" 4k monitor and typically run it the render scale at 85. It’s a little blurry, but still usable for me. I don’t even bother with FSR 2.0 (AMD’s equivalent to DLSS), so give DX12 a try with regular TAA antialiasing. I’ve seen a number of DLSS blurry complaints, so you may like TAA better. When I had an i5-8400, DX12 helped with stutters even though the average frame rates were about the same. Then again the DX11 vs 12 debate is not likely to be soon settled because everyone’s system is different.