Bit of an update, I think I may know what it is...
Buggy CPU/Motherboard.
When I play anything where the CPU usage is above 80%, or a single core is doing a lot of work (dota) it starts doing it.
If I CPU limit myself in Red Dead Online, I can see it to some degree, not loads, but 100fps and low GPU usage feels a fair bit worse than cranking up the graphics and running at say 60-70fps. Again, only seems to be on a mouse which is odd, I guess controller movement is slower though so maybe is masked by that?
This sort of explains to me why battlefield 5 online immediately feels terrible (but feeling great with a controller which throws me off a bit)
I've also noticed if I play BF5 practice range, no stuttering at all, implying CPU again? I only get it on BF5 in multiplayer matches.
I've tried to replicate with other games, but can't get CPU high enough to really tell. Company of Heroes 2 feels a similar thing, but then CPU and GPU usage are both sub 50%.
I've got another PSU lying around, might try that out to see if its a power thing (pretty sure I've already tried this PSU, but no harm trying again)
If that doesn't work, I might buy a B550 board to see if that makes a difference as it's cheaper than a CPU change.
EDIT - Tested a 80+ plat PSU...No difference. Losing my sanity over this lol, can't tell what I'm even seeing anymore.