It runs much worse than it should for me, and I don't even have everything maxed. Running an i7 @ 3.6 and 3x 470 SC in Tri-SLI.
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Do you play in fullscreen or windowed? because SLI does not work in windowed mode, therefore if you switch to full screen you should see a large performance increase, but there is also the terrible latancy and the speed of the HDD which both cause lag as well, which is why a SSD helps alot.
It doesn't even work well with 2x SLI mode according to some user feedbacks. Crossfire scales better it seems(that's my impression). To avoid the stuttering in town (or other places with many people) they have to reduce the poly counts for non-ultra-highend GPUs and make the loading algorithm async with a big cache. Currently it's like this: something needs to load = your game stops.
The shadows also need some rework, but that's really low priority.
BUT is it just my imagination or does disabling the shadows do nothing performance-wise? Are they rendered even if they are disabled? lol
SSD doesn't fix choppiness. Using a 50 GB OCZ Vertex II with only OS and FFXIV installed and I still have choppiness, all the time, with graphics set to "Standard" across the board. Especially during weather effects. Rest of my PC is of similar quality (Radeon 5850, 3.2 Q9550, 8 GB RAM). I can run anything perfectly except FFXIV. :(
Your choppiness is due to the weak HD5850. It just can't handle this many polygons in crowded areas. With my HD5870 I get 60 fps most of the time. If I play fullscreen and use Crossfire I always get 60 fps.
You can set everything to highest except general drawing (8) and AO. There isn't much difference since the polygon count is the same.