FPS drops in delirium

My specs:

AMD Ryzen 7 7800X3D
32GB DDR5 6000
AMD RX 9070 XT 16GB

In high levels of Delirium such as simmulacrum or even just running deli mirror with breach & beyond on strand map I am having spikes when I drop below 10 fps and usual die as result. During these spikes I can see the cpu response time going from 4-10 ms to 80-110ms.

I've tried tons of different configurations, and I have not been able to get it to feel good. This is my current setup which is a D+ rating at best.

Typically the first 3/4ths of the map are fine but the higher level of delirium I go the laggier it gets. Same with Sims wave 12+ starts getting very laggy.

Renderer: DirectX12
Render Resolution: Quality
VSync: Off
Foreground Cap: 60 (Enabled)
Background Cap: 30 (Enabled)
Antialiasing: Off
Upscale Mode: FSR
Sharpness: 100%
Lighting: Shadows
Shadow Quality: Low
Sun shadow Quality: Low
Number of lights: Low
Bloom: 25%
Depth of Field: Disabled
Water Detail Level: low
Texture Quality: High
Texture Filtering: 8x

Dynamic Culling: Enabled
Dynamic Resolution: Enabled
Target Framerate: 60
Engine Multithreading: Enabled

Turns out the mana reservation rune graft was causing most of the lag. After removing it I was pretty much lag free again.